Provider Demographics
NPI:1770905705
Name:EMERE UTAH, LLC
Entity type:Organization
Organization Name:EMERE UTAH, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:ALAN
Authorized Official - Middle Name:
Authorized Official - Last Name:COTTLE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:801-617-2100
Mailing Address - Street 1:PO BOX 1468
Mailing Address - Street 2:
Mailing Address - City:BOUNTIFUL
Mailing Address - State:UT
Mailing Address - Zip Code:84011-1468
Mailing Address - Country:US
Mailing Address - Phone:801-296-2113
Mailing Address - Fax:801-296-1715
Practice Address - Street 1:5296 S COMMERCE DR
Practice Address - Street 2:SUITE 104
Practice Address - City:MURRAY
Practice Address - State:UT
Practice Address - Zip Code:84107-4767
Practice Address - Country:US
Practice Address - Phone:385-474-8888
Practice Address - Fax:801-590-8123
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-01-10
Last Update Date:2014-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2081S0010XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationSports MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT1770905705Medicaid
UTU000086893Medicare PIN