Provider Demographics
NPI:1619248754
Name:CHOICE CARE CLINIC OF UTAH, INC.
Entity Type:Organization
Organization Name:CHOICE CARE CLINIC OF UTAH, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:A
Authorized Official - Last Name:CARTER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:801-984-3407
Mailing Address - Street 1:117 SEABOARD LN BLDG E
Mailing Address - Street 2:ATTN: IASIS CORPORATE LEGAL DEPARTMENT
Mailing Address - City:FRANKLIN
Mailing Address - State:TN
Mailing Address - Zip Code:37067-2855
Mailing Address - Country:US
Mailing Address - Phone:615-844-2747
Mailing Address - Fax:615-467-1271
Practice Address - Street 1:406 W SOUTH JORDAN PKWY
Practice Address - Street 2:SUITE 450
Practice Address - City:SOUTH JORDAN
Practice Address - State:UT
Practice Address - Zip Code:84095-3965
Practice Address - Country:US
Practice Address - Phone:801-984-3418
Practice Address - Fax:801-984-3479
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-01-20
Last Update Date:2012-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Multi-Specialty