Provider Demographics
NPI:1972510717
Name:UTAH GASTROENTEROLOGY LLC
Entity Type:Organization
Organization Name:UTAH GASTROENTEROLOGY LLC
Other - Org Name:FKA MOUNTAIN WEST GASTROENTEROLOGY, P.C.
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:CORPORATE ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:CHRISTINE
Authorized Official - Middle Name:
Authorized Official - Last Name:MORRIS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:801-944-3191
Mailing Address - Street 1:6360 SOUTH 3000 EAST
Mailing Address - Street 2:SUITE 220
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84121
Mailing Address - Country:US
Mailing Address - Phone:801-944-3199
Mailing Address - Fax:801-944-3180
Practice Address - Street 1:6360 SOUTH 3000 EAST
Practice Address - Street 2:SUITE 310
Practice Address - City:SALT LAKE CITY
Practice Address - State:UT
Practice Address - Zip Code:84121
Practice Address - Country:US
Practice Address - Phone:801-944-3144
Practice Address - Fax:801-944-3186
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:UTAH GASTROENTEROLOGY LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-08-02
Last Update Date:2021-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT000055322Medicare PIN