Provider Demographics
NPI:1578224671
Name:COUNTRY HEALTHCARE LLC
Entity Type:Organization
Organization Name:COUNTRY HEALTHCARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:VIRGINIA
Authorized Official - Middle Name:
Authorized Official - Last Name:JEFFERIES
Authorized Official - Suffix:
Authorized Official - Credentials:FNP-C
Authorized Official - Phone:385-352-5545
Mailing Address - Street 1:35 N 500 W
Mailing Address - Street 2:
Mailing Address - City:LEHI
Mailing Address - State:UT
Mailing Address - Zip Code:84043-1755
Mailing Address - Country:US
Mailing Address - Phone:385-352-5545
Mailing Address - Fax:385-352-1003
Practice Address - Street 1:35 N 500 W
Practice Address - Street 2:
Practice Address - City:LEHI
Practice Address - State:UT
Practice Address - Zip Code:84043-1755
Practice Address - Country:US
Practice Address - Phone:385-383-3103
Practice Address - Fax:385-352-1003
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-01-01
Last Update Date:2023-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty
No261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care