Provider Demographics
NPI:1629230958
Name:MOUNTAIN WEST CARDIOVASCULAR ASSOCIATES
Entity Type:Organization
Organization Name:MOUNTAIN WEST CARDIOVASCULAR ASSOCIATES
Other - Org Name:HEART CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CREDENTIALING COORDINATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:TERI
Authorized Official - Middle Name:J
Authorized Official - Last Name:WARDLE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:801-676-3723
Mailing Address - Street 1:5169 COTTONWOOD ST
Mailing Address - Street 2:SUITE B620
Mailing Address - City:MURRAY
Mailing Address - State:UT
Mailing Address - Zip Code:84107-6767
Mailing Address - Country:US
Mailing Address - Phone:801-507-8600
Mailing Address - Fax:801-507-8602
Practice Address - Street 1:5169 COTTONWOOD ST
Practice Address - Street 2:SUITE B620
Practice Address - City:MURRAY
Practice Address - State:UT
Practice Address - Zip Code:84158
Practice Address - Country:US
Practice Address - Phone:801-507-8600
Practice Address - Fax:801-507-8602
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-06-27
Last Update Date:2011-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty