Provider Demographics
NPI:1679675417
Name:AFTER HOURS MEDICAL LLC, DBA MEDALLUS MEDICAL
Entity Type:Organization
Organization Name:AFTER HOURS MEDICAL LLC, DBA MEDALLUS MEDICAL
Other - Org Name:AFTER HOURS MEDICAL- WEST VALLEY CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:COMPLIANCE ADMIN ASST/ CREDENTIALIN
Authorized Official - Prefix:MRS
Authorized Official - First Name:MONIQUE
Authorized Official - Middle Name:S
Authorized Official - Last Name:ARAGON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:801-260-1919
Mailing Address - Street 1:PO BOX 1000
Mailing Address - Street 2:
Mailing Address - City:DRAPER
Mailing Address - State:UT
Mailing Address - Zip Code:84020-1000
Mailing Address - Country:US
Mailing Address - Phone:801-352-9500
Mailing Address - Fax:801-352-9502
Practice Address - Street 1:3451 S 5600 W
Practice Address - Street 2:SUITE #F
Practice Address - City:WEST VALLEY
Practice Address - State:UT
Practice Address - Zip Code:84120-1301
Practice Address - Country:US
Practice Address - Phone:801-957-0900
Practice Address - Fax:801-966-4384
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-02
Last Update Date:2024-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary CareGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT1437251279Medicaid
UT000057490Medicare PIN