Provider Demographics
NPI:1558653899
Name:DR CALVINS CLINIC
Entity Type:Organization
Organization Name:DR CALVINS CLINIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:CALVIN
Authorized Official - Middle Name:M
Authorized Official - Last Name:BEAUGEZ
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:801-973-1022
Mailing Address - Street 1:2250 S REDWOOD RD
Mailing Address - Street 2:STE 1
Mailing Address - City:WEST VALLEY CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84119-1348
Mailing Address - Country:US
Mailing Address - Phone:801-973-1022
Mailing Address - Fax:801-973-0090
Practice Address - Street 1:2250 S REDWOOD RD
Practice Address - Street 2:STE 1
Practice Address - City:WEST VALLEY CITY
Practice Address - State:UT
Practice Address - Zip Code:84119-1348
Practice Address - Country:US
Practice Address - Phone:801-973-1022
Practice Address - Fax:801-973-0090
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-05-04
Last Update Date:2011-05-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT334984-1202261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center