Provider Demographics
NPI:1568721496
Name:COMPREHENSIVE MEDICAL SERVICES JORDAN HEALTH AND WELLNESS CENTER, INC
Entity Type:Organization
Organization Name:COMPREHENSIVE MEDICAL SERVICES JORDAN HEALTH AND WELLNESS CENTER, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:BRYAN
Authorized Official - Middle Name:W
Authorized Official - Last Name:TURNER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:801-327-8700
Mailing Address - Street 1:677 W 5300 S
Mailing Address - Street 2:
Mailing Address - City:MURRAY
Mailing Address - State:UT
Mailing Address - Zip Code:84123-5671
Mailing Address - Country:US
Mailing Address - Phone:801-327-8700
Mailing Address - Fax:844-848-7926
Practice Address - Street 1:677 W 5300 S
Practice Address - Street 2:
Practice Address - City:MURRAY
Practice Address - State:UT
Practice Address - Zip Code:84123-5671
Practice Address - Country:US
Practice Address - Phone:801-327-8700
Practice Address - Fax:844-848-7926
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-05-13
Last Update Date:2016-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT2621351205261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
G23036Medicare UPIN