Provider Demographics
NPI:1093301566
Name:PREMIER FAMILY MEDICAL - VINEYARD
Entity Type:Organization
Organization Name:PREMIER FAMILY MEDICAL - VINEYARD
Other - Org Name:PREMIER FAMILY MEDICAL - VINEYARD
Other - Org Type:Doing Business As
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 1:275 W 200 N
Mailing Address - Street 2:
Mailing Address - City:LINDON
Mailing Address - State:UT
Mailing Address - Zip Code:84042-5009
Mailing Address - Country:US
Mailing Address - Phone:801-769-2560
Mailing Address - Fax:801-443-1164
Practice Address - Street 1:707 E MILL RD STE 303
Practice Address - Street 2:
Practice Address - City:VINEYARD
Practice Address - State:UT
Practice Address - Zip Code:84059-5730
Practice Address - Country:US
Practice Address - Phone:801-224-1300
Practice Address - Fax:801-225-3236
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:PREMIER FAMILY MEDICAL
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2020-12-17
Last Update Date:2024-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty