Provider Demographics
NPI:1417378712
Name:SPECIALTY CARE GROUP, LLC
Entity Type:Organization
Organization Name:SPECIALTY CARE GROUP, LLC
Other - Org Name:SPECIALTY CARE GROUP
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CHIEF EXECUTIVE OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:
Authorized Official - Last Name:ROBLEDO-DUNN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:801-327-9696
Mailing Address - Street 1:9980 S 300 W
Mailing Address - Street 2:SUITE 200
Mailing Address - City:SANDY
Mailing Address - State:UT
Mailing Address - Zip Code:84070-3627
Mailing Address - Country:US
Mailing Address - Phone:801-327-9696
Mailing Address - Fax:801-931-2605
Practice Address - Street 1:9980 S 300 W
Practice Address - Street 2:SUITE 200
Practice Address - City:SANDY
Practice Address - State:UT
Practice Address - Zip Code:84070-3627
Practice Address - Country:US
Practice Address - Phone:801-327-9696
Practice Address - Fax:801-931-2605
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-01-04
Last Update Date:2014-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management