Provider Demographics
NPI:1720702434
Name:UTAH AIDS FOUNDATION
Entity Type:Organization
Organization Name:UTAH AIDS FOUNDATION
Other - Org Name:UAF LEGACY HEALTH
Other - Org Type:Doing Business As
Authorized Official - Title/Position:VP OF CLINICAL OPERATIONS & TECHNOL
Authorized Official - Prefix:
Authorized Official - First Name:IAN
Authorized Official - Middle Name:
Authorized Official - Last Name:MCMAHAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:801-487-2323
Mailing Address - Street 1:150 S 1000 E
Mailing Address - Street 2:
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84102-1443
Mailing Address - Country:US
Mailing Address - Phone:801-487-2323
Mailing Address - Fax:801-486-3987
Practice Address - Street 1:150 S 1000 E
Practice Address - Street 2:
Practice Address - City:SALT LAKE CITY
Practice Address - State:UT
Practice Address - Zip Code:84102-1443
Practice Address - Country:US
Practice Address - Phone:801-487-2323
Practice Address - Fax:801-486-3987
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-09-27
Last Update Date:2023-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-Specialty