Provider Demographics
NPI:1720759236
Name:MTC MEDICAL, LLC
Entity Type:Organization
Organization Name:MTC MEDICAL, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:FINANCE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:GABE
Authorized Official - Middle Name:
Authorized Official - Last Name:UTLEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:801-693-2918
Mailing Address - Street 1:500 N MARKET PLACE DR STE 100
Mailing Address - Street 2:
Mailing Address - City:CENTERVILLE
Mailing Address - State:UT
Mailing Address - Zip Code:84014-1711
Mailing Address - Country:US
Mailing Address - Phone:801-693-2918
Mailing Address - Fax:
Practice Address - Street 1:500 N MARKET PLACE DR STE 100
Practice Address - Street 2:
Practice Address - City:CENTERVILLE
Practice Address - State:UT
Practice Address - Zip Code:84014-1711
Practice Address - Country:US
Practice Address - Phone:801-693-2918
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-09-23
Last Update Date:2021-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2400XAmbulatory Health Care FacilitiesClinic/CenterPrison Health
No261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-Specialty