Provider Demographics
NPI:1669862447
Name:AFTER HOURS MEDICAL LLC
Entity Type:Organization
Organization Name:AFTER HOURS MEDICAL LLC
Other - Org Name:MEDALLUS MEDICAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER / CEO
Authorized Official - Prefix:
Authorized Official - First Name:RACHOT
Authorized Official - Middle Name:
Authorized Official - Last Name:VACHAROTHONE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:801-260-1919
Mailing Address - Street 1:PO BOX 95970
Mailing Address - Street 2:
Mailing Address - City:SOUTH JORDAN
Mailing Address - State:UT
Mailing Address - Zip Code:84095-0970
Mailing Address - Country:US
Mailing Address - Phone:801-352-9500
Mailing Address - Fax:801-352-9502
Practice Address - Street 1:2450 EXECUTIVE PARKWAY
Practice Address - Street 2:
Practice Address - City:LEHI
Practice Address - State:UT
Practice Address - Zip Code:84043-3737
Practice Address - Country:US
Practice Address - Phone:801-753-5555
Practice Address - Fax:801-260-1441
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-01-30
Last Update Date:2015-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT000057490Medicare PIN