Provider Demographics
NPI:1518266501
Name:ASPEN CLINICAL RESEARCH, LLC
Entity Type:Organization
Organization Name:ASPEN CLINICAL RESEARCH, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXEC. V.P. BUSINESS DEVELOPMENT
Authorized Official - Prefix:
Authorized Official - First Name:IAN
Authorized Official - Middle Name:M
Authorized Official - Last Name:DAWE
Authorized Official - Suffix:
Authorized Official - Credentials:BSN, RN, BSW
Authorized Official - Phone:801-356-5555
Mailing Address - Street 1:1215 S 1680 W
Mailing Address - Street 2:
Mailing Address - City:OREM
Mailing Address - State:UT
Mailing Address - Zip Code:84058-4939
Mailing Address - Country:US
Mailing Address - Phone:801-356-5555
Mailing Address - Fax:801-224-6010
Practice Address - Street 1:1215 S 1680 W
Practice Address - Street 2:
Practice Address - City:OREM
Practice Address - State:UT
Practice Address - Zip Code:84058-4939
Practice Address - Country:US
Practice Address - Phone:801-356-5555
Practice Address - Fax:801-224-6010
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-03-16
Last Update Date:2020-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT6777624-0160261QR1100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR1100XAmbulatory Health Care FacilitiesClinic/CenterResearch
Provider Identifiers
StateIdentifier IDID TypeIssuer
1912008590OtherMICHAEL W. HARRIS, DO