Provider Demographics
NPI:1649375270
Name:MEDICAL ARTS CENTER CLINIC OF BRIGHAM CITY INC
Entity type:Organization
Organization Name:MEDICAL ARTS CENTER CLINIC OF BRIGHAM CITY INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR/PARTNER
Authorized Official - Prefix:DR
Authorized Official - First Name:LYNN
Authorized Official - Middle Name:Q
Authorized Official - Last Name:BEARD
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:435-723-5248
Mailing Address - Street 1:984 MEDICAL DR STE 1
Mailing Address - Street 2:
Mailing Address - City:BRIGHAM CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84302-4712
Mailing Address - Country:US
Mailing Address - Phone:435-723-5248
Mailing Address - Fax:435-723-5240
Practice Address - Street 1:984 MEDICAL DR STE 1
Practice Address - Street 2:
Practice Address - City:BRIGHAM CITY
Practice Address - State:UT
Practice Address - Zip Code:84302-4712
Practice Address - Country:US
Practice Address - Phone:435-723-5248
Practice Address - Fax:877-395-5866
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-14
Last Update Date:2020-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
No207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT000055098Medicare ID - Type Unspecified