Provider Demographics
NPI:1437330974
Name:DR JOHN FOLEY LLC
Entity Type:Organization
Organization Name:DR JOHN FOLEY LLC
Other - Org Name:ROCKY MOUNTAIN MS CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR OF OPERATIONS
Authorized Official - Prefix:
Authorized Official - First Name:SYDNEY
Authorized Official - Middle Name:
Authorized Official - Last Name:VIVANCO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:801-408-5700
Mailing Address - Street 1:370 E 9TH AVE STE 106
Mailing Address - Street 2:
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84103-3182
Mailing Address - Country:US
Mailing Address - Phone:801-408-5700
Mailing Address - Fax:801-408-5704
Practice Address - Street 1:370 E 9TH AVE STE 106
Practice Address - Street 2:
Practice Address - City:SALT LAKE CITY
Practice Address - State:UT
Practice Address - Zip Code:84103-3182
Practice Address - Country:US
Practice Address - Phone:014-085-7008
Practice Address - Fax:801-408-5704
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-26
Last Update Date:2023-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT171994-1205207T00000X
2084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurologyGroup - Single Specialty
No207T00000XAllopathic & Osteopathic PhysiciansNeurological SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT1437330974Medicaid
UTP00283132OtherRAILROAD MEDICARE
UT1437330974Medicaid
UT000058122Medicare PIN