Provider Demographics
NPI:1487656781
Name:TOOELE CLINIC CORPORATION
Entity type:Organization
Organization Name:TOOELE CLINIC CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SENIOR GROUP VP
Authorized Official - Prefix:MR
Authorized Official - First Name:MICHAELE
Authorized Official - Middle Name:
Authorized Official - Last Name:PORTACCI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:615-309-3340
Mailing Address - Street 1:330 FRANKLIN RD
Mailing Address - Street 2:
Mailing Address - City:BRENTWOOD
Mailing Address - State:TN
Mailing Address - Zip Code:37027-3280
Mailing Address - Country:US
Mailing Address - Phone:615-309-3338
Mailing Address - Fax:
Practice Address - Street 1:330 FRANKLIN RD #135A-304
Practice Address - Street 2:
Practice Address - City:BRENTWOOD
Practice Address - State:TN
Practice Address - Zip Code:37027-3280
Practice Address - Country:US
Practice Address - Phone:615-309-3338
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-06-01
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT87063588207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty