Provider Demographics
NPI:1952953101
Name:RESTORATIVE HEALTH PRIMARY CARE
Entity Type:Organization
Organization Name:RESTORATIVE HEALTH PRIMARY CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PARTNER
Authorized Official - Prefix:
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:
Authorized Official - Last Name:BEESLEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:385-449-0565
Mailing Address - Street 1:850 E 9400 S STE 101
Mailing Address - Street 2:
Mailing Address - City:SANDY
Mailing Address - State:UT
Mailing Address - Zip Code:84094-4114
Mailing Address - Country:US
Mailing Address - Phone:385-449-0565
Mailing Address - Fax:
Practice Address - Street 1:850 E 9400 S STE 101
Practice Address - Street 2:
Practice Address - City:SANDY
Practice Address - State:UT
Practice Address - Zip Code:84094-4114
Practice Address - Country:US
Practice Address - Phone:385-449-0565
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-07-09
Last Update Date:2019-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT14053329OtherCOUNCIL FOR AFFORDABLE QUALITY HEALTHCARE (CAQH) PROVIDER ID