Provider Demographics
NPI:1578707352
Name:MOUNTAIN SPRINGS FAMILY MEDICINE, PLLC
Entity Type:Organization
Organization Name:MOUNTAIN SPRINGS FAMILY MEDICINE, PLLC
Other - Org Name:HEALTH REJUVENATION INSTITUTE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:RANDY
Authorized Official - Middle Name:R
Authorized Official - Last Name:LUNDELL
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:801-504-6117
Mailing Address - Street 1:954 N 200 E STE 954
Mailing Address - Street 2:
Mailing Address - City:SPANISH FORK
Mailing Address - State:UT
Mailing Address - Zip Code:84660-1247
Mailing Address - Country:US
Mailing Address - Phone:801-504-6117
Mailing Address - Fax:801-504-6328
Practice Address - Street 1:954 N 200 E STE 954
Practice Address - Street 2:
Practice Address - City:SPANISH FORK
Practice Address - State:UT
Practice Address - Zip Code:84660
Practice Address - Country:US
Practice Address - Phone:801-504-6117
Practice Address - Fax:801-504-6328
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-04-24
Last Update Date:2018-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty