Basic Information
| Provider Information | |||||||||
| NPI: | 1548683410 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | MARK MILES PASSEY MD PC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 48 W BROADWAY APT 2001 | ||||||||
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| City: | SALT LAKE CITY | ||||||||
| State: | UT | ||||||||
| PostalCode: | 841012015 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8013142308 | ||||||||
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| Practice Location | |||||||||
| Address1: | 5872 S 900 E | ||||||||
| Address2: | 250 | ||||||||
| City: | SALT LAKE CITY | ||||||||
| State: | UT | ||||||||
| PostalCode: | 841211676 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8013142308 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 01/29/2014 | ||||||||
| LastUpdateDate: | 01/29/2014 | ||||||||
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| AuthorizedOfficialLastName: | PASSEY | ||||||||
| AuthorizedOfficialFirstName: | MARK | ||||||||
| AuthorizedOfficialMiddleName: | MILES | ||||||||
| AuthorizedOfficialTitleorPosition: | PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 8013142308 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | M.D. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261QP3300X | 81-167082-1205 | UT | Y | Ambulatory Health Care Facilities | Clinic/Center | Pain |
No ID Information.