Provider Demographics
NPI:1407294614
Name:TEEM FAMILY CLINIC, P.C.
Entity Type:Organization
Organization Name:TEEM FAMILY CLINIC, P.C.
Other - Org Name:TEEM FAMILY CLINIC
Other - Org Type:Other Name
Authorized Official - Title/Position:BOARD DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:LORI
Authorized Official - Middle Name:
Authorized Official - Last Name:TEEM
Authorized Official - Suffix:
Authorized Official - Credentials:FNP
Authorized Official - Phone:435-722-4705
Mailing Address - Street 1:990 CLUB HOUSE DR
Mailing Address - Street 2:
Mailing Address - City:ROOSEVELT
Mailing Address - State:UT
Mailing Address - Zip Code:84066-2203
Mailing Address - Country:US
Mailing Address - Phone:435-722-4705
Mailing Address - Fax:435-738-8338
Practice Address - Street 1:31 EAST 800 NORTH
Practice Address - Street 2:
Practice Address - City:DUCHESNE
Practice Address - State:UT
Practice Address - Zip Code:84066-0238
Practice Address - Country:US
Practice Address - Phone:435-738-8336
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-06-10
Last Update Date:2013-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT215999-4405261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center