Provider Demographics
NPI:1770050684
Name:BEDROCK HEALTH CENTER, PLLC
Entity type:Organization
Organization Name:BEDROCK HEALTH CENTER, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:TAMI
Authorized Official - Middle Name:L
Authorized Official - Last Name:PEARCE
Authorized Official - Suffix:
Authorized Official - Credentials:FNP-C
Authorized Official - Phone:801-372-5899
Mailing Address - Street 1:347 N 300 W STE 203
Mailing Address - Street 2:
Mailing Address - City:KAYSVILLE
Mailing Address - State:UT
Mailing Address - Zip Code:84037-1828
Mailing Address - Country:US
Mailing Address - Phone:801-593-1660
Mailing Address - Fax:801-593-1663
Practice Address - Street 1:347 N 300 W STE 203
Practice Address - Street 2:
Practice Address - City:KAYSVILLE
Practice Address - State:UT
Practice Address - Zip Code:84037-1828
Practice Address - Country:US
Practice Address - Phone:801-593-1660
Practice Address - Fax:801-593-1663
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-10-29
Last Update Date:2018-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service