Provider Demographics
NPI:1720747207
Name:UTAH PODIATRY GROUP PC
Entity Type:Organization
Organization Name:UTAH PODIATRY GROUP PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DPM OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SCOTT
Authorized Official - Middle Name:A
Authorized Official - Last Name:CLARK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:801-505-5277
Mailing Address - Street 1:2561 S 1560 W STE B
Mailing Address - Street 2:
Mailing Address - City:WOODS CROSS
Mailing Address - State:UT
Mailing Address - Zip Code:84087-2361
Mailing Address - Country:US
Mailing Address - Phone:801-505-0821
Mailing Address - Fax:801-505-0803
Practice Address - Street 1:210 E MAIN ST
Practice Address - Street 2:
Practice Address - City:SANTAQUIN
Practice Address - State:UT
Practice Address - Zip Code:84655-7076
Practice Address - Country:US
Practice Address - Phone:801-373-2499
Practice Address - Fax:801-373-5200
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:UTAH PODIATRY GROUP PC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2021-12-13
Last Update Date:2021-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP1100XAmbulatory Health Care FacilitiesClinic/CenterPodiatric