Provider Demographics
NPI:1801562921
Name:CLS MEDICAL LLC
Entity type:Organization
Organization Name:CLS MEDICAL LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:CASEY
Authorized Official - Middle Name:L
Authorized Official - Last Name:STELTER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:801-771-7235
Mailing Address - Street 1:PO BOX 1009
Mailing Address - Street 2:
Mailing Address - City:RIVERTON
Mailing Address - State:UT
Mailing Address - Zip Code:84065-1009
Mailing Address - Country:US
Mailing Address - Phone:801-561-8398
Mailing Address - Fax:801-302-0645
Practice Address - Street 1:2743 N 2125 E
Practice Address - Street 2:
Practice Address - City:LAYTON
Practice Address - State:UT
Practice Address - Zip Code:84040-3206
Practice Address - Country:US
Practice Address - Phone:801-771-7235
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-08-18
Last Update Date:2021-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty