Provider Demographics
NPI:1184271215
Name:HC HEALTHCARE, LLC
Entity type:Organization
Organization Name:HC HEALTHCARE, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:KAMIE
Authorized Official - Middle Name:
Authorized Official - Last Name:PRIOR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:435-245-6248
Mailing Address - Street 1:26 W MAIN ST STE 3A
Mailing Address - Street 2:
Mailing Address - City:HYRUM
Mailing Address - State:UT
Mailing Address - Zip Code:84319-1206
Mailing Address - Country:US
Mailing Address - Phone:435-245-6248
Mailing Address - Fax:435-213-9882
Practice Address - Street 1:26 W MAIN ST # 3A
Practice Address - Street 2:
Practice Address - City:HYRUM
Practice Address - State:UT
Practice Address - Zip Code:84319-1206
Practice Address - Country:US
Practice Address - Phone:435-245-6248
Practice Address - Fax:435-213-9882
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-08-22
Last Update Date:2021-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT1033156849OtherBRANT FONNESBECK DO
UT1184271215OtherGROUP NPI
UT1699322693OtherCASSIE MILLIGAN NP