Organization Name: | TRI CITY MEDICAL CLINIC INC |
NPI Number: | 1043421753 |
Entity Type Code: | Organizational (2) |
Authorized Official Name: | MARSHALL F WILLIS (CEO) |
Mailing Address: | 447 E 1000 S Pleasant Grove |
State: | UT US |
Postal Code: | 840623623 |
Phone Number: | 8017563511 |
Fax Number: | 8017561705 |
NPI Enumeration Date: | 05/24/2007 |
NPI Last Update Date: | 12/19/2008 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 261QP2000X |
License Number: | |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | |
Taxonomy Type: | Ambulatory Health Care Facilities |
Taxonomy Classification: | Clinic/Center |
Taxonomy Specialization: | Physical Therapy |
Taxonomy Definition: |