Provider Demographics
NPI:1508299892
Name:UTAH PARTNERS FOR HEALTH
Entity Type:Organization
Organization Name:UTAH PARTNERS FOR HEALTH
Other - Org Name:MID-VALLEY HEALTH CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:KURT
Authorized Official - Middle Name:
Authorized Official - Last Name:MICKA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:801-417-0131
Mailing Address - Street 1:8446 S HARRISON ST
Mailing Address - Street 2:
Mailing Address - City:MIDVALE
Mailing Address - State:UT
Mailing Address - Zip Code:84047-3501
Mailing Address - Country:US
Mailing Address - Phone:801-417-0131
Mailing Address - Fax:801-250-3204
Practice Address - Street 1:8446 S HARRISON ST
Practice Address - Street 2:
Practice Address - City:MIDVALE
Practice Address - State:UT
Practice Address - Zip Code:84047-3501
Practice Address - Country:US
Practice Address - Phone:801-417-0131
Practice Address - Fax:801-250-3204
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-08-09
Last Update Date:2013-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center