Provider Demographics
NPI:1851155857
Name:ACCIDENT RECOVERY CLINIC OF UTAH, LLC
Entity Type:Organization
Organization Name:ACCIDENT RECOVERY CLINIC OF UTAH, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:IAN
Authorized Official - Middle Name:
Authorized Official - Last Name:DAWE
Authorized Official - Suffix:
Authorized Official - Credentials:APRN
Authorized Official - Phone:303-412-2175
Mailing Address - Street 1:841 W 1100 N
Mailing Address - Street 2:
Mailing Address - City:PLEASANT GROVE
Mailing Address - State:UT
Mailing Address - Zip Code:84062-9647
Mailing Address - Country:US
Mailing Address - Phone:303-412-2175
Mailing Address - Fax:385-786-8987
Practice Address - Street 1:5817 ASCENSION WAY
Practice Address - Street 2:
Practice Address - City:MURRAY
Practice Address - State:UT
Practice Address - Zip Code:84123
Practice Address - Country:US
Practice Address - Phone:303-412-2175
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-02-09
Last Update Date:2024-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGroup - Single Specialty