Provider Demographics
NPI:1497976245
Name:TRI CITY MEDICAL CLINIC INC
Entity Type:Organization
Organization Name:TRI CITY MEDICAL CLINIC INC
Other - Org Name:PLEASANT GROVE FAMILY PRACTICE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PARTNER
Authorized Official - Prefix:DR
Authorized Official - First Name:STEVEN
Authorized Official - Middle Name:B
Authorized Official - Last Name:CHERRINGTON
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:801-443-1135
Mailing Address - Street 1:275 W 200 N
Mailing Address - Street 2:#100
Mailing Address - City:LINDON
Mailing Address - State:UT
Mailing Address - Zip Code:84042
Mailing Address - Country:US
Mailing Address - Phone:801-443-1135
Mailing Address - Fax:801-756-1705
Practice Address - Street 1:275 W 200 N
Practice Address - Street 2:#100
Practice Address - City:LINDON
Practice Address - State:UT
Practice Address - Zip Code:84042
Practice Address - Country:US
Practice Address - Phone:801-443-1135
Practice Address - Fax:801-756-1705
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-01
Last Update Date:2008-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT=========001Medicaid
UT1018060001Medicare NSC
000055159Medicare PIN