Provider Demographics
NPI:1417283359
Name:CANYON CREST HEART & HEALTH L.L.C.
Entity Type:Organization
Organization Name:CANYON CREST HEART & HEALTH L.L.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRINCIPAL
Authorized Official - Prefix:DR
Authorized Official - First Name:MARK
Authorized Official - Middle Name:H
Authorized Official - Last Name:KEEP
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:801-696-8485
Mailing Address - Street 1:11762 S STATE ST
Mailing Address - Street 2:
Mailing Address - City:DRAPER
Mailing Address - State:UT
Mailing Address - Zip Code:84020-7155
Mailing Address - Country:US
Mailing Address - Phone:801-696-8485
Mailing Address - Fax:801-272-3101
Practice Address - Street 1:11762 S STATE ST
Practice Address - Street 2:
Practice Address - City:DRAPER
Practice Address - State:UT
Practice Address - Zip Code:84020-7155
Practice Address - Country:US
Practice Address - Phone:801-696-8485
Practice Address - Fax:801-272-3101
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-10-28
Last Update Date:2009-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RI0011XAllopathic & Osteopathic PhysiciansInternal MedicineInterventional CardiologyGroup - Single Specialty