Basic Information
| Provider Information | |||||||||
| NPI: | 1083905244 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | WORK CARE-NORTH, LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 271395 | ||||||||
| Address2: | |||||||||
| City: | SALT LAKE CITY | ||||||||
| State: | UT | ||||||||
| PostalCode: | 841260692 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8017733400 | ||||||||
| FaxNumber: | 8017733401 | ||||||||
| Practice Location | |||||||||
| Address1: | 2084 N 1700 W #D | ||||||||
| Address2: | |||||||||
| City: | LAYTON | ||||||||
| State: | UT | ||||||||
| PostalCode: | 840411194 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8017733400 | ||||||||
| FaxNumber: | 8017733401 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/22/2011 | ||||||||
| LastUpdateDate: | 04/22/2011 | ||||||||
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| AuthorizedOfficialLastName: | ANDERSON | ||||||||
| AuthorizedOfficialFirstName: | MARK | ||||||||
| AuthorizedOfficialMiddleName: | V | ||||||||
| AuthorizedOfficialTitleorPosition: | PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 8019751600 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MR. | ||||||||
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| AuthorizedOfficialCredential: | MD | ||||||||
| NPICertificationDate: | |||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261Q00000X | UT | Y | Ambulatory Health Care Facilities | Clinic/Center |
No ID Information.