Provider Demographics
NPI:1477259083
Name:ACCIDENT MD, LLC
Entity type:Organization
Organization Name:ACCIDENT MD, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:OKSANA
Authorized Official - Middle Name:V
Authorized Official - Last Name:JACOBY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:801-999-1166
Mailing Address - Street 1:3020 E GRANITE MEADOW LN
Mailing Address - Street 2:
Mailing Address - City:SANDY
Mailing Address - State:UT
Mailing Address - Zip Code:84092-3516
Mailing Address - Country:US
Mailing Address - Phone:801-999-1166
Mailing Address - Fax:
Practice Address - Street 1:279 E 5900 S
Practice Address - Street 2:
Practice Address - City:MURRAY
Practice Address - State:UT
Practice Address - Zip Code:84107-5421
Practice Address - Country:US
Practice Address - Phone:801-999-1133
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-02-06
Last Update Date:2023-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-Specialty