Provider Demographics
NPI:1548753866
Name:PROMISE MEDICAL PLLC
Entity Type:Organization
Organization Name:PROMISE MEDICAL PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ANNE
Authorized Official - Middle Name:E
Authorized Official - Last Name:VINCENT
Authorized Official - Suffix:
Authorized Official - Credentials:APRN
Authorized Official - Phone:385-262-4135
Mailing Address - Street 1:159 N 400 W UNIT B-8
Mailing Address - Street 2:
Mailing Address - City:OREM
Mailing Address - State:UT
Mailing Address - Zip Code:84057-1909
Mailing Address - Country:US
Mailing Address - Phone:385-262-4135
Mailing Address - Fax:801-899-7996
Practice Address - Street 1:159 N 400 W UNIT B-8
Practice Address - Street 2:
Practice Address - City:OREM
Practice Address - State:UT
Practice Address - Zip Code:84057-1909
Practice Address - Country:US
Practice Address - Phone:385-262-4135
Practice Address - Fax:801-899-7996
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-06-12
Last Update Date:2024-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT281795-4405261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care