Provider Demographics
NPI:1528204922
Name:COMPREHENSIVE FAMILY CLINIC
Entity Type:Organization
Organization Name:COMPREHENSIVE FAMILY CLINIC
Other - Org Name:LAKESIDE MEDICAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:ERIK
Authorized Official - Middle Name:
Authorized Official - Last Name:MOLL
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:801-974-3382
Mailing Address - Street 1:4701 W 2100 S
Mailing Address - Street 2:BUILDING 3
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84120-1223
Mailing Address - Country:US
Mailing Address - Phone:801-974-3382
Mailing Address - Fax:801-974-3295
Practice Address - Street 1:4701 W 2100 S
Practice Address - Street 2:BUILDING 3
Practice Address - City:SALT LAKE CITY
Practice Address - State:UT
Practice Address - Zip Code:84120-1223
Practice Address - Country:US
Practice Address - Phone:801-974-3382
Practice Address - Fax:801-974-3295
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:CR ENGLAND, INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2009-01-06
Last Update Date:2009-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT6787397-1202111N00000X
UT151129-1205208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Multi-Specialty
No111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty