Provider Demographics
NPI:1750460259
Name:SOUTH VALLEY WOMEN'S HEALTH CARE, PC
Entity Type:Organization
Organization Name:SOUTH VALLEY WOMEN'S HEALTH CARE, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:CAROL
Authorized Official - Middle Name:
Authorized Official - Last Name:CHRISTENSEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:801-569-5310
Mailing Address - Street 1:13825 S. REDWOOD RD. #200
Mailing Address - Street 2:
Mailing Address - City:BLUFFDALE
Mailing Address - State:UT
Mailing Address - Zip Code:84065
Mailing Address - Country:US
Mailing Address - Phone:801-569-2626
Mailing Address - Fax:801-569-5333
Practice Address - Street 1:13825 S. REDWOOD RD. #200
Practice Address - Street 2:
Practice Address - City:BLUFFDALE
Practice Address - State:UT
Practice Address - Zip Code:84065
Practice Address - Country:US
Practice Address - Phone:801-569-2626
Practice Address - Fax:801-569-5333
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-03
Last Update Date:2021-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT000055148Medicare PIN