Provider Demographics
NPI:1659731941
Name:LIFE HEALTH MEDICAL CENTER, INC.
Entity Type:Organization
Organization Name:LIFE HEALTH MEDICAL CENTER, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MATTHEW
Authorized Official - Middle Name:PAUL
Authorized Official - Last Name:WOOD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:801-450-6940
Mailing Address - Street 1:2277 E ARBOR LN
Mailing Address - Street 2:
Mailing Address - City:SLC
Mailing Address - State:UT
Mailing Address - Zip Code:84117-5351
Mailing Address - Country:US
Mailing Address - Phone:801-944-5900
Mailing Address - Fax:801-944-5910
Practice Address - Street 1:1770 E FORT UNION BLVD STE 101
Practice Address - Street 2:
Practice Address - City:SALT LAKE CITY
Practice Address - State:UT
Practice Address - Zip Code:84121-2881
Practice Address - Country:US
Practice Address - Phone:801-944-5900
Practice Address - Fax:801-944-5910
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-02-29
Last Update Date:2016-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Single Specialty