Provider Demographics
NPI:1780367466
Name:WASATCH MEDICAL CLINIC,LLC
Entity type:Organization
Organization Name:WASATCH MEDICAL CLINIC,LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:WANDA
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:SOLORIO
Authorized Official - Suffix:
Authorized Official - Credentials:PA-C/FNP
Authorized Official - Phone:209-485-0954
Mailing Address - Street 1:PO BOX 274
Mailing Address - Street 2:
Mailing Address - City:RIVERTON
Mailing Address - State:UT
Mailing Address - Zip Code:84065-0274
Mailing Address - Country:US
Mailing Address - Phone:801-893-2682
Mailing Address - Fax:385-351-9686
Practice Address - Street 1:235 W 9000 S
Practice Address - Street 2:
Practice Address - City:SANDY
Practice Address - State:UT
Practice Address - Zip Code:84070-2049
Practice Address - Country:US
Practice Address - Phone:801-893-2682
Practice Address - Fax:385-351-9686
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-08-09
Last Update Date:2023-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service