Provider Demographics
NPI:1619159795
Name:WESTERN GYNECOLOGICAL AND OBSTETRICAL CLINIC, INC.
Entity Type:Organization
Organization Name:WESTERN GYNECOLOGICAL AND OBSTETRICAL CLINIC, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTICE ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:MINDY
Authorized Official - Middle Name:
Authorized Official - Last Name:THORNE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:801-285-4800
Mailing Address - Street 1:12842 S 3600 W STE 200
Mailing Address - Street 2:
Mailing Address - City:RIVERTON
Mailing Address - State:UT
Mailing Address - Zip Code:84065-6853
Mailing Address - Country:US
Mailing Address - Phone:801-285-4800
Mailing Address - Fax:801-285-4801
Practice Address - Street 1:12842 S 3600 W STE 200
Practice Address - Street 2:
Practice Address - City:RIVERTON
Practice Address - State:UT
Practice Address - Zip Code:84065-6853
Practice Address - Country:US
Practice Address - Phone:801-285-4800
Practice Address - Fax:801-285-4801
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-30
Last Update Date:2021-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT1499-07207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT000007044Medicare PIN