Provider Demographics
NPI:1295197614
Name:DOCTORS AT HOME WITH DIGNITY
Entity Type:Organization
Organization Name:DOCTORS AT HOME WITH DIGNITY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:BRICE
Authorized Official - Middle Name:NEFF
Authorized Official - Last Name:WILSON
Authorized Official - Suffix:II
Authorized Official - Credentials:MBA
Authorized Official - Phone:801-492-4892
Mailing Address - Street 1:765 E 340 S STE 104
Mailing Address - Street 2:
Mailing Address - City:AMERICAN FORK
Mailing Address - State:UT
Mailing Address - Zip Code:84003-3347
Mailing Address - Country:US
Mailing Address - Phone:385-715-6400
Mailing Address - Fax:888-271-5631
Practice Address - Street 1:831 E 340 S STE 230
Practice Address - Street 2:
Practice Address - City:AMERICAN FORK
Practice Address - State:UT
Practice Address - Zip Code:84003-3493
Practice Address - Country:US
Practice Address - Phone:801-492-4892
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-03-24
Last Update Date:2016-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Single Specialty
No363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantGroup - Single Specialty
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGroup - Single Specialty