Provider Demographics
NPI:1831247121
Name:MOUNTAIN WEST CARDIOVASCULAR ASSOCIATES
Entity type:Organization
Organization Name:MOUNTAIN WEST CARDIOVASCULAR ASSOCIATES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:TERI
Authorized Official - Middle Name:J
Authorized Official - Last Name:WARDLE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:801-676-3723
Mailing Address - Street 1:5810 FASHION BLVD
Mailing Address - Street 2:SUITE 216
Mailing Address - City:MURRAY
Mailing Address - State:UT
Mailing Address - Zip Code:84107-6178
Mailing Address - Country:US
Mailing Address - Phone:801-314-4630
Mailing Address - Fax:
Practice Address - Street 1:5810 FASHION BLVD
Practice Address - Street 2:SUITE 216
Practice Address - City:MURRAY
Practice Address - State:UT
Practice Address - Zip Code:84107-6178
Practice Address - Country:US
Practice Address - Phone:801-314-4630
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-05
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty