Provider Demographics
NPI:1407029275
Name:STONEBROOK MEDICAL L.L.C
Entity Type:Organization
Organization Name:STONEBROOK MEDICAL L.L.C
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MYRNA
Authorized Official - Middle Name:L
Authorized Official - Last Name:LOVELESS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:801-763-7803
Mailing Address - Street 1:36 N 1100 E
Mailing Address - Street 2:SUITE D
Mailing Address - City:AMERICAN FORK
Mailing Address - State:UT
Mailing Address - Zip Code:84003-2918
Mailing Address - Country:US
Mailing Address - Phone:801-763-7803
Mailing Address - Fax:801-763-7810
Practice Address - Street 1:36 N 1100 E
Practice Address - Street 2:SUITE D
Practice Address - City:AMERICAN FORK
Practice Address - State:UT
Practice Address - Zip Code:84003-2918
Practice Address - Country:US
Practice Address - Phone:801-763-7803
Practice Address - Fax:801-763-7810
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-11
Last Update Date:2008-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT4591261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center