Provider Demographics
NPI:1710925128
Name:MOUNTAIN WEST CARDIOVASCULAR ASSOCIATES
Entity Type:Organization
Organization Name:MOUNTAIN WEST CARDIOVASCULAR ASSOCIATES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:TERI
Authorized Official - Middle Name:J
Authorized Official - Last Name:WARDLE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:801-982-2215
Mailing Address - Street 1:24 S 1100 E
Mailing Address - Street 2:SUITE 105
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84102-1500
Mailing Address - Country:US
Mailing Address - Phone:801-266-3418
Mailing Address - Fax:801-288-4444
Practice Address - Street 1:24 S 1100 E
Practice Address - Street 2:SUITE 105
Practice Address - City:SALT LAKE CITY
Practice Address - State:UT
Practice Address - Zip Code:84102-1500
Practice Address - Country:US
Practice Address - Phone:801-266-3418
Practice Address - Fax:801-288-4444
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-04
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty