Provider Demographics
NPI:1851634224
Name:UTAH VALLEY FAMILY MEDICINE RESIDENCY
Entity Type:Organization
Organization Name:UTAH VALLEY FAMILY MEDICINE RESIDENCY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:RESIDENCY COORDINATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:MICHELLE
Authorized Official - Middle Name:
Authorized Official - Last Name:JUDD
Authorized Official - Suffix:
Authorized Official - Credentials:BS
Authorized Official - Phone:801-357-7926
Mailing Address - Street 1:475 W. 940 S.
Mailing Address - Street 2:
Mailing Address - City:PROVO
Mailing Address - State:UT
Mailing Address - Zip Code:84604
Mailing Address - Country:US
Mailing Address - Phone:801-357-7926
Mailing Address - Fax:801-357-7927
Practice Address - Street 1:475 W. 940 S.
Practice Address - Street 2:
Practice Address - City:PROVO
Practice Address - State:UT
Practice Address - Zip Code:84604-3301
Practice Address - Country:US
Practice Address - Phone:801-357-7926
Practice Address - Fax:801-357-7927
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:INTERMOUNTAIN HEALTHCARE
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2013-04-03
Last Update Date:2013-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care