Provider Demographics
NPI:1508067950
Name:PARK CITY HEALTHCARE, PC
Entity Type:Organization
Organization Name:PARK CITY HEALTHCARE, PC
Other - Org Name:PARK CITY CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:STEPHEN
Authorized Official - Middle Name:F
Authorized Official - Last Name:SWANSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:435-649-7640
Mailing Address - Street 1:P.O. BOX 680670
Mailing Address - Street 2:
Mailing Address - City:PARK CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84068
Mailing Address - Country:US
Mailing Address - Phone:435-649-7640
Mailing Address - Fax:435-776-9353
Practice Address - Street 1:1665 BONANZA DRIVE
Practice Address - Street 2:
Practice Address - City:PARK CITY
Practice Address - State:UT
Practice Address - Zip Code:84060
Practice Address - Country:US
Practice Address - Phone:435-649-7640
Practice Address - Fax:435-649-1365
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-31
Last Update Date:2011-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes173000000XOther Service ProvidersLegal MedicineGroup - Multi-Specialty