Provider Demographics
NPI:1043762479
Name:PREMIER FAMILY MEDICAL - EAGLE MOUNTAIN
Entity Type:Organization
Organization Name:PREMIER FAMILY MEDICAL - EAGLE MOUNTAIN
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CREDENTIALING SPECIALIST
Authorized Official - Prefix:
Authorized Official - First Name:HEATHER
Authorized Official - Middle Name:
Authorized Official - Last Name:GUYMON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:801-769-2571
Mailing Address - Street 1:3943 E PONY EXPRESS PKWY STE 120
Mailing Address - Street 2:
Mailing Address - City:EAGLE MOUNTAIN
Mailing Address - State:UT
Mailing Address - Zip Code:84005-5543
Mailing Address - Country:US
Mailing Address - Phone:801-789-5566
Mailing Address - Fax:801-642-2941
Practice Address - Street 1:3943 E PONY EXPRESS PKWY STE 120
Practice Address - Street 2:
Practice Address - City:EAGLE MOUNTAIN
Practice Address - State:UT
Practice Address - Zip Code:84005-5543
Practice Address - Country:US
Practice Address - Phone:801-756-3511
Practice Address - Fax:801-756-1705
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:PREMIER FAMILY MEDICAL
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2016-11-02
Last Update Date:2024-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty