Provider Demographics
NPI:1558611418
Name:UTAH CENTER FOR MEDICAL WEIGHT LOSS, LLC
Entity Type:Organization
Organization Name:UTAH CENTER FOR MEDICAL WEIGHT LOSS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MD/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ANDREW
Authorized Official - Middle Name:M
Authorized Official - Last Name:HEINER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:801-619-9000
Mailing Address - Street 1:9829 S 1300 E
Mailing Address - Street 2:STE 302
Mailing Address - City:SANDY
Mailing Address - State:UT
Mailing Address - Zip Code:84094-4000
Mailing Address - Country:US
Mailing Address - Phone:801-727-2035
Mailing Address - Fax:801-572-7779
Practice Address - Street 1:9829 S 1300 E
Practice Address - Street 2:STE 302
Practice Address - City:SANDY
Practice Address - State:UT
Practice Address - Zip Code:84094-4000
Practice Address - Country:US
Practice Address - Phone:801-727-2035
Practice Address - Fax:801-572-7779
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-09-18
Last Update Date:2012-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty