Provider Demographics
NPI:1093834038
Name:MOUNTAIN MEDICAL URGENT CARE
Entity Type:Organization
Organization Name:MOUNTAIN MEDICAL URGENT CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:STEVEN
Authorized Official - Middle Name:R
Authorized Official - Last Name:PACK
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:801-768-1555
Mailing Address - Street 1:1311 E WILLOW SPRINGS CIR
Mailing Address - Street 2:
Mailing Address - City:ALPINE
Mailing Address - State:UT
Mailing Address - Zip Code:84004-1790
Mailing Address - Country:US
Mailing Address - Phone:801-756-6086
Mailing Address - Fax:
Practice Address - Street 1:127 EAST MAIN STREET
Practice Address - Street 2:SUITE E
Practice Address - City:LEHI
Practice Address - State:UT
Practice Address - Zip Code:84043
Practice Address - Country:US
Practice Address - Phone:801-768-1555
Practice Address - Fax:801-768-1569
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-29
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QE0002XAmbulatory Health Care FacilitiesClinic/CenterEmergency Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT529087890001Medicaid
UTF04696Medicare UPIN