Provider Demographics
NPI:1821376161
Name:ALPSUTAH, INC
Entity Type:Organization
Organization Name:ALPSUTAH, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:GARY
Authorized Official - Middle Name:LEE
Authorized Official - Last Name:CHILD
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:801-766-6055
Mailing Address - Street 1:PO BOX 261
Mailing Address - Street 2:
Mailing Address - City:LEHI
Mailing Address - State:UT
Mailing Address - Zip Code:84043-0261
Mailing Address - Country:US
Mailing Address - Phone:801-766-6055
Mailing Address - Fax:888-611-8840
Practice Address - Street 1:945 W 3200 N
Practice Address - Street 2:
Practice Address - City:LEHI
Practice Address - State:UT
Practice Address - Zip Code:84043-9771
Practice Address - Country:US
Practice Address - Phone:801-766-6055
Practice Address - Fax:888-611-8840
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-08-03
Last Update Date:2011-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT7112893-1204261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
UTEO3550Medicare UPIN