Provider Demographics
NPI:1497204903
Name:WHITE TREE MEDICAL CONSULTANTS LLC
Entity Type:Organization
Organization Name:WHITE TREE MEDICAL CONSULTANTS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:CL
Authorized Official - Middle Name:
Authorized Official - Last Name:CANFIELD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:801-877-0705
Mailing Address - Street 1:PO BOX 709391
Mailing Address - Street 2:
Mailing Address - City:SANDY
Mailing Address - State:UT
Mailing Address - Zip Code:84070-9391
Mailing Address - Country:US
Mailing Address - Phone:801-877-0705
Mailing Address - Fax:801-335-5957
Practice Address - Street 1:10437 S JORDAN GTWY
Practice Address - Street 2:
Practice Address - City:SOUTH JORDAN
Practice Address - State:UT
Practice Address - Zip Code:84095
Practice Address - Country:US
Practice Address - Phone:801-877-0705
Practice Address - Fax:801-335-5957
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-09-26
Last Update Date:2018-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207QA0401XAllopathic & Osteopathic PhysiciansFamily MedicineAddiction MedicineGroup - Multi-Specialty
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Multi-Specialty
No163WA0400XNursing Service ProvidersRegistered NurseAddiction (Substance Use Disorder)Group - Multi-Specialty
No207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
No261QR0405XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation, Substance Use Disorder
No310500000XNursing & Custodial Care FacilitiesIntermediate Care Facility, Mental Illness
No324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation FacilityGroup - Multi-Specialty