Provider Demographics
NPI:1790998359
Name:WASATCH PEAK FAMILY PRACTICE INC
Entity Type:Organization
Organization Name:WASATCH PEAK FAMILY PRACTICE INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:LYNETTE
Authorized Official - Middle Name:
Authorized Official - Last Name:CHOWNING
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:801-773-4770
Mailing Address - Street 1:1580 W ANTELOPE DR
Mailing Address - Street 2:SUITE 200
Mailing Address - City:LAYTON
Mailing Address - State:UT
Mailing Address - Zip Code:84041-1160
Mailing Address - Country:US
Mailing Address - Phone:801-773-4770
Mailing Address - Fax:801-773-4776
Practice Address - Street 1:1580 W ANTELOPE DR
Practice Address - Street 2:SUITE 200
Practice Address - City:LAYTON
Practice Address - State:UT
Practice Address - Zip Code:84041-1160
Practice Address - Country:US
Practice Address - Phone:801-773-4770
Practice Address - Fax:801-773-4776
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-08
Last Update Date:2015-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Single Specialty