Provider Demographics
NPI:1487836532
Name:AMAZING MEDICAL ASSOCIATES, INC
Entity Type:Organization
Organization Name:AMAZING MEDICAL ASSOCIATES, INC
Other - Org Name:AMG SENIOR MEDICAL GROUP
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CHIEF OPERATING OFFICER
Authorized Official - Prefix:MR
Authorized Official - First Name:NATHAN
Authorized Official - Middle Name:
Authorized Official - Last Name:BLASIER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:801-716-7008
Mailing Address - Street 1:434 W ASCENSION WAY STE 225
Mailing Address - Street 2:
Mailing Address - City:MURRAY
Mailing Address - State:UT
Mailing Address - Zip Code:84123-2790
Mailing Address - Country:US
Mailing Address - Phone:801-716-7008
Mailing Address - Fax:888-990-1557
Practice Address - Street 1:434 W ASCENSION WAY STE 225
Practice Address - Street 2:
Practice Address - City:MURRAY
Practice Address - State:UT
Practice Address - Zip Code:84123
Practice Address - Country:US
Practice Address - Phone:801-716-7008
Practice Address - Fax:888-990-1557
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-30
Last Update Date:2024-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT311210-1205207Q00000X
261QM1300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-Specialty
No207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
UTDA3651Medicare PIN
UTDA3651Medicare PIN