Provider Demographics
NPI:1497316905
Name:THE WEST CLINIC DRAPER
Entity Type:Organization
Organization Name:THE WEST CLINIC DRAPER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:WARREN
Authorized Official - Middle Name:
Authorized Official - Last Name:WILLEY
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:385-247-0775
Mailing Address - Street 1:12371 S 900 E
Mailing Address - Street 2:
Mailing Address - City:DRAPER
Mailing Address - State:UT
Mailing Address - Zip Code:84020-9833
Mailing Address - Country:US
Mailing Address - Phone:385-247-0775
Mailing Address - Fax:
Practice Address - Street 1:12371 S 900 E
Practice Address - Street 2:
Practice Address - City:DRAPER
Practice Address - State:UT
Practice Address - Zip Code:84020-9833
Practice Address - Country:US
Practice Address - Phone:385-247-0775
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-06-25
Last Update Date:2019-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM2500XAmbulatory Health Care FacilitiesClinic/CenterMedical Specialty