Provider Demographics
NPI:1912137084
Name:DENNIS W. REMINGTON M.D. ,P.C.
Entity Type:Organization
Organization Name:DENNIS W. REMINGTON M.D. ,P.C.
Other - Org Name:FREEDOM MEDICAL CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PHYSICIA
Authorized Official - Prefix:DR
Authorized Official - First Name:DENNIS
Authorized Official - Middle Name:W
Authorized Official - Last Name:REMINGTON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:801-373-8500
Mailing Address - Street 1:1675 N FREEDOM BLVD STE 11E
Mailing Address - Street 2:
Mailing Address - City:PROVO
Mailing Address - State:UT
Mailing Address - Zip Code:84604-6936
Mailing Address - Country:US
Mailing Address - Phone:801-373-8500
Mailing Address - Fax:801-373-3426
Practice Address - Street 1:1675 N FREEDOM BLVD STE 11E
Practice Address - Street 2:
Practice Address - City:PROVO
Practice Address - State:UT
Practice Address - Zip Code:84604-6936
Practice Address - Country:US
Practice Address - Phone:801-373-8500
Practice Address - Fax:801-373-3426
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-07-22
Last Update Date:2009-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT1647951205261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center