Provider Demographics
NPI:1477269199
Name:THE SMART CLINIC
Entity Type:Organization
Organization Name:THE SMART CLINIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BILLING MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:MARCI
Authorized Official - Middle Name:
Authorized Official - Last Name:MERRILL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:801-676-7627
Mailing Address - Street 1:P.O. BOX 900280
Mailing Address - Street 2:
Mailing Address - City:SANDY
Mailing Address - State:UT
Mailing Address - Zip Code:84090
Mailing Address - Country:US
Mailing Address - Phone:801-676-7627
Mailing Address - Fax:801-676-7629
Practice Address - Street 1:4518 N. FOREST DALE DRIVE
Practice Address - Street 2:SUITE I-53
Practice Address - City:PARK CITY
Practice Address - State:UT
Practice Address - Zip Code:84098
Practice Address - Country:US
Practice Address - Phone:801-676-7627
Practice Address - Fax:801-676-7629
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-01-26
Last Update Date:2023-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationGroup - Multi-Specialty