Provider Demographics
NPI:1255570453
Name:SHEPARD CREEK OB-GYN, P.C.
Entity type:Organization
Organization Name:SHEPARD CREEK OB-GYN, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:NEIL
Authorized Official - Middle Name:O
Authorized Official - Last Name:SPENCER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:801-447-3377
Mailing Address - Street 1:670 SHEPARD LN STE 103
Mailing Address - Street 2:
Mailing Address - City:FARMINGTON
Mailing Address - State:UT
Mailing Address - Zip Code:84025-3936
Mailing Address - Country:US
Mailing Address - Phone:801-447-3377
Mailing Address - Fax:801-447-3442
Practice Address - Street 1:670 SHEPARD LN STE 103
Practice Address - Street 2:
Practice Address - City:FARMINGTON
Practice Address - State:UT
Practice Address - Zip Code:84025-3936
Practice Address - Country:US
Practice Address - Phone:801-447-3377
Practice Address - Fax:801-447-3442
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-02-11
Last Update Date:2020-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT891804611205174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT528111737021Medicaid
UTF99580Medicare UPIN