Provider Demographics
NPI:1497928147
Name:TOTAL CONCEPT HEALTH CARE
Entity type:Organization
Organization Name:TOTAL CONCEPT HEALTH CARE
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:DOCTOR AND EXECUTIVE CHEIF
Authorized Official - Prefix:DR
Authorized Official - First Name:DANEE
Authorized Official - Middle Name:S
Authorized Official - Last Name:YOUNG
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:435-750-0366
Mailing Address - Street 1:920 N 200 W
Mailing Address - Street 2:SUITE A
Mailing Address - City:LOGAN
Mailing Address - State:UT
Mailing Address - Zip Code:84321-3200
Mailing Address - Country:US
Mailing Address - Phone:435-750-0366
Mailing Address - Fax:435-750-0377
Practice Address - Street 1:920 N 200 W
Practice Address - Street 2:SUITE A
Practice Address - City:LOGAN
Practice Address - State:UT
Practice Address - Zip Code:84321-3200
Practice Address - Country:US
Practice Address - Phone:435-750-0366
Practice Address - Fax:435-750-0377
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-02
Last Update Date:2008-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT183608-1205208600000X, 207VG0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207VG0400XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecologyGroup - Multi-Specialty
No208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT553068427005Medicaid
UTE70247Medicare UPIN