Provider Demographics
NPI:1497014096
Name:UPRI MURRAY
Entity Type:Organization
Organization Name:UPRI MURRAY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:SHANTELLE
Authorized Official - Middle Name:DANAE NILLA QURESHI
Authorized Official - Last Name:PRATT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:801-327-9336
Mailing Address - Street 1:32 W WINCHESTER ST
Mailing Address - Street 2:SUITE 100
Mailing Address - City:MURRAY
Mailing Address - State:UT
Mailing Address - Zip Code:84107-5607
Mailing Address - Country:US
Mailing Address - Phone:801-281-0555
Mailing Address - Fax:801-281-0444
Practice Address - Street 1:32 W WINCHESTER ST
Practice Address - Street 2:SUITE 200
Practice Address - City:MURRAY
Practice Address - State:UT
Practice Address - Zip Code:84107-5607
Practice Address - Country:US
Practice Address - Phone:801-281-0555
Practice Address - Fax:801-281-0444
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-05-16
Last Update Date:2021-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT7112893-1204207QA0401X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207QA0401XAllopathic & Osteopathic PhysiciansFamily MedicineAddiction MedicineGroup - Single Specialty