Provider Demographics
NPI:1790718492
Name:UTAH HYPERBARIC PHYSICIANS
Entity Type:Organization
Organization Name:UTAH HYPERBARIC PHYSICIANS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:TOMMY
Authorized Official - Middle Name:L
Authorized Official - Last Name:LOVE
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:801-397-0890
Mailing Address - Street 1:520 MEDICAL DR STE 110
Mailing Address - Street 2:
Mailing Address - City:BOUNTIFUL
Mailing Address - State:UT
Mailing Address - Zip Code:84010-8931
Mailing Address - Country:US
Mailing Address - Phone:801-397-0890
Mailing Address - Fax:801-299-7899
Practice Address - Street 1:520 MEDICAL DR STE 110
Practice Address - Street 2:
Practice Address - City:BOUNTIFUL
Practice Address - State:UT
Practice Address - Zip Code:84010-8931
Practice Address - Country:US
Practice Address - Phone:801-397-0890
Practice Address - Fax:801-299-7899
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-08
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2083P0011XAllopathic & Osteopathic PhysiciansPreventive MedicineUndersea and Hyperbaric MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT=========003Medicaid