Provider Demographics
NPI:1184000366
Name:VISTA MEDICAL CENTERS LLC
Entity Type:Organization
Organization Name:VISTA MEDICAL CENTERS LLC
Other - Org Name:VISTA SPINE & INJURY CARE CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ERIC
Authorized Official - Middle Name:C
Authorized Official - Last Name:LEE
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:801-756-7800
Mailing Address - Street 1:1062 E BAMBERGER DR
Mailing Address - Street 2:
Mailing Address - City:AMERICAN FORK
Mailing Address - State:UT
Mailing Address - Zip Code:84003-5504
Mailing Address - Country:US
Mailing Address - Phone:801-756-7800
Mailing Address - Fax:
Practice Address - Street 1:3590 W 9000 S STE 240
Practice Address - Street 2:
Practice Address - City:WEST JORDAN
Practice Address - State:UT
Practice Address - Zip Code:84088-8864
Practice Address - Country:US
Practice Address - Phone:801-756-7800
Practice Address - Fax:801-756-7805
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-08-10
Last Update Date:2020-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty
No208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Multi-Specialty