Provider Demographics
NPI:1780215509
Name:NUCOR FAMILY CLINIC
Entity Type:Organization
Organization Name:NUCOR FAMILY CLINIC
Other - Org Name:NUCOR FAMILY CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OPERATIONS MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:DARCE
Authorized Official - Middle Name:
Authorized Official - Last Name:LATSIS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:801-441-1002
Mailing Address - Street 1:560 S 300 E STE 275
Mailing Address - Street 2:
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84111-3586
Mailing Address - Country:US
Mailing Address - Phone:801-441-1002
Mailing Address - Fax:
Practice Address - Street 1:3601 PAUL R LOWRY RD
Practice Address - Street 2:
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38109-3007
Practice Address - Country:US
Practice Address - Phone:901-520-6400
Practice Address - Fax:901-520-6401
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ONSITE CARE CLINICS
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2020-01-30
Last Update Date:2020-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center