Provider Demographics
NPI:1528197597
Name:PERSONAL CHOICE MEDICAL CENTER LLC
Entity Type:Organization
Organization Name:PERSONAL CHOICE MEDICAL CENTER LLC
Other - Org Name:ALPINE CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:DIANNE
Authorized Official - Middle Name:
Authorized Official - Last Name:FARLEY-JONES
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:801-407-3000
Mailing Address - Street 1:3300 RUNNING CREEK WAY
Mailing Address - Street 2:BUILDING B SUITE 100
Mailing Address - City:LEHI
Mailing Address - State:UT
Mailing Address - Zip Code:84043-5563
Mailing Address - Country:US
Mailing Address - Phone:801-407-3000
Mailing Address - Fax:801-407-3001
Practice Address - Street 1:3300 RUNNING CREEK WAY
Practice Address - Street 2:BUILDING B SUITE 100
Practice Address - City:LEHI
Practice Address - State:UT
Practice Address - Zip Code:84043-5563
Practice Address - Country:US
Practice Address - Phone:801-407-3000
Practice Address - Fax:801-407-3001
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-05
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT901827771205207Q00000X
UT2171328900363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Not Answered207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
Not Answered363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGroup - Multi-Specialty