Provider Demographics
NPI:1700965308
Name:HTI PHYSICIAN SERVICES OF UTAH, INC
Entity Type:Organization
Organization Name:HTI PHYSICIAN SERVICES OF UTAH, INC
Other - Org Name:MORGAN HEALTH CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:AREA PRACTICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:KRISTIN
Authorized Official - Middle Name:
Authorized Official - Last Name:SUMMERS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:801-479-7771
Mailing Address - Street 1:PO BOX 1007
Mailing Address - Street 2:
Mailing Address - City:MORGAN
Mailing Address - State:UT
Mailing Address - Zip Code:84050-1007
Mailing Address - Country:US
Mailing Address - Phone:801-829-3426
Mailing Address - Fax:801-829-3135
Practice Address - Street 1:166 NORTH STATE ST
Practice Address - Street 2:
Practice Address - City:MORGAN
Practice Address - State:UT
Practice Address - Zip Code:84050-0000
Practice Address - Country:US
Practice Address - Phone:801-829-3426
Practice Address - Fax:801-829-3135
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-03
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT564423673039Medicaid