Provider Demographics
NPI:1952498735
Name:MOUNTAIN WEST CARDIOVASCULAR ASSOCIATES, PC
Entity Type:Organization
Organization Name:MOUNTAIN WEST CARDIOVASCULAR ASSOCIATES, PC
Other - Org Name:HEART CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CREDENTIALING COORDINATOR
Authorized Official - Prefix:
Authorized Official - First Name:TERI
Authorized Official - Middle Name:J
Authorized Official - Last Name:WARDLE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:801-676-3723
Mailing Address - Street 1:3584 W 9000 S
Mailing Address - Street 2:SUITE 209
Mailing Address - City:WEST JORDAN
Mailing Address - State:UT
Mailing Address - Zip Code:84088
Mailing Address - Country:US
Mailing Address - Phone:801-676-3776
Mailing Address - Fax:801-676-0987
Practice Address - Street 1:3584 W 9000 S
Practice Address - Street 2:SUITE 209
Practice Address - City:WEST JORDAN
Practice Address - State:UT
Practice Address - Zip Code:84088
Practice Address - Country:US
Practice Address - Phone:801-676-3776
Practice Address - Fax:801-676-0987
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-05
Last Update Date:2011-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty