Provider Demographics
NPI:1568928133
Name:ATLAS MEDICAL UTAH LLC
Entity Type:Organization
Organization Name:ATLAS MEDICAL UTAH LLC
Other - Org Name:SENTRY MEDICAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:TYLER
Authorized Official - Middle Name:
Authorized Official - Last Name:PACE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:435-383-6120
Mailing Address - Street 1:258 S MAIN ST STE 210
Mailing Address - Street 2:
Mailing Address - City:LOGAN
Mailing Address - State:UT
Mailing Address - Zip Code:84321-5768
Mailing Address - Country:US
Mailing Address - Phone:435-383-6120
Mailing Address - Fax:435-557-8003
Practice Address - Street 1:258 S MAIN ST STE 210
Practice Address - Street 2:
Practice Address - City:LOGAN
Practice Address - State:UT
Practice Address - Zip Code:84321-5768
Practice Address - Country:US
Practice Address - Phone:435-383-6120
Practice Address - Fax:435-557-8003
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-02-19
Last Update Date:2023-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty