Provider Demographics
NPI:1508649567
Name:MIDTOWN COMMUNITY HEALTH CENTER INC
Entity Type:Organization
Organization Name:MIDTOWN COMMUNITY HEALTH CENTER INC
Other - Org Name:PHARMACY SOUTH SALT LAKE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:SONJA
Authorized Official - Middle Name:M
Authorized Official - Last Name:LEVESQUE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:801-334-1327
Mailing Address - Street 1:2240 ADAMS AVE
Mailing Address - Street 2:
Mailing Address - City:OGDEN
Mailing Address - State:UT
Mailing Address - Zip Code:84401-1511
Mailing Address - Country:US
Mailing Address - Phone:801-334-1327
Mailing Address - Fax:
Practice Address - Street 1:60 E 3750 S
Practice Address - Street 2:
Practice Address - City:SOUTH SALT LAKE
Practice Address - State:UT
Practice Address - Zip Code:84115-4428
Practice Address - Country:US
Practice Address - Phone:801-262-3315
Practice Address - Fax:801-262-3595
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-08-15
Last Update Date:2024-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy