Provider Demographics
NPI:1376912089
Name:EAST WEST HEALTH PARK CITY
Entity Type:Organization
Organization Name:EAST WEST HEALTH PARK CITY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PARTNER
Authorized Official - Prefix:
Authorized Official - First Name:REGAN
Authorized Official - Middle Name:
Authorized Official - Last Name:ARCHIBALD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:435-640-1353
Mailing Address - Street 1:1790 SUN PEAK DR
Mailing Address - Street 2:SUITE B106
Mailing Address - City:PARK CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84098-6559
Mailing Address - Country:US
Mailing Address - Phone:435-640-1353
Mailing Address - Fax:
Practice Address - Street 1:1790 SUN PEAK DR STE A102
Practice Address - Street 2:
Practice Address - City:PARK CITY
Practice Address - State:UT
Practice Address - Zip Code:84098-6651
Practice Address - Country:US
Practice Address - Phone:435-640-1353
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-09-23
Last Update Date:2020-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT5743144-1201171100000X
UT4803531-1205208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171100000XOther Service ProvidersAcupuncturistGroup - Multi-Specialty
No208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Multi-Specialty