Provider Demographics
NPI:1821321597
Name:UTAH COUNTY MEDICAL ASSOCIATES
Entity Type:Organization
Organization Name:UTAH COUNTY MEDICAL ASSOCIATES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:CHRIS
Authorized Official - Middle Name:
Authorized Official - Last Name:CROCKETT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:801-465-4899
Mailing Address - Street 1:97 PROFESSIONAL WAY
Mailing Address - Street 2:SUITE 2
Mailing Address - City:PAYSON
Mailing Address - State:UT
Mailing Address - Zip Code:84651-1614
Mailing Address - Country:US
Mailing Address - Phone:801-465-4896
Mailing Address - Fax:801-465-3267
Practice Address - Street 1:376 E 400 S
Practice Address - Street 2:
Practice Address - City:SPRINGVILLE
Practice Address - State:UT
Practice Address - Zip Code:84663-1977
Practice Address - Country:US
Practice Address - Phone:801-477-1400
Practice Address - Fax:801-489-0777
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:UTAH COUNTY MEDICAL ASSOCIATES
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2009-09-14
Last Update Date:2009-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT184332-1205207Q00000X
UT175869-1205207Q00000X
UT7376450-1204207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Multi-Specialty
No207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty