Provider Demographics
NPI:1770853962
Name:HILLSIDE MEDICAL CLINIC LLC
Entity Type:Organization
Organization Name:HILLSIDE MEDICAL CLINIC LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:CHAD
Authorized Official - Middle Name:A
Authorized Official - Last Name:PARRISH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:801-477-9007
Mailing Address - Street 1:118 N MAIN ST STE B
Mailing Address - Street 2:
Mailing Address - City:SALEM
Mailing Address - State:UT
Mailing Address - Zip Code:84653-5698
Mailing Address - Country:US
Mailing Address - Phone:801-477-9007
Mailing Address - Fax:801-477-9006
Practice Address - Street 1:118 N MAIN ST STE B
Practice Address - Street 2:
Practice Address - City:SALEM
Practice Address - State:UT
Practice Address - Zip Code:84653-5698
Practice Address - Country:US
Practice Address - Phone:801-477-9007
Practice Address - Fax:801-477-9006
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-01-05
Last Update Date:2012-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care