Provider Demographics
NPI:1124419296
Name:JASMER HEALTH LLC
Entity Type:Organization
Organization Name:JASMER HEALTH LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:DUSTIN
Authorized Official - Middle Name:CHASE
Authorized Official - Last Name:JASMER
Authorized Official - Suffix:
Authorized Official - Credentials:FNP
Authorized Official - Phone:801-628-5256
Mailing Address - Street 1:2317 N HILL FIELD RD STE 103
Mailing Address - Street 2:
Mailing Address - City:LAYTON
Mailing Address - State:UT
Mailing Address - Zip Code:84041-4782
Mailing Address - Country:US
Mailing Address - Phone:801-525-4645
Mailing Address - Fax:801-779-7808
Practice Address - Street 1:1536 N 1375 W
Practice Address - Street 2:
Practice Address - City:CLINTON
Practice Address - State:UT
Practice Address - Zip Code:84015-6731
Practice Address - Country:US
Practice Address - Phone:801-628-5256
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-02-11
Last Update Date:2015-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT1558439117Medicaid
UTPTAN 000055196Medicare PIN