Basic Information
| Provider Information | |||||||||
| NPI: | 1851634224 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | UTAH VALLEY FAMILY MEDICINE RESIDENCY | ||||||||
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| Mailing Information | |||||||||
| Address1: | 475 W. 940 S. | ||||||||
| Address2: | |||||||||
| City: | PROVO | ||||||||
| State: | UT | ||||||||
| PostalCode: | 84604 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8013577926 | ||||||||
| FaxNumber: | 8013577927 | ||||||||
| Practice Location | |||||||||
| Address1: | 475 W. 940 S. | ||||||||
| Address2: | |||||||||
| City: | PROVO | ||||||||
| State: | UT | ||||||||
| PostalCode: | 846043301 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8013577926 | ||||||||
| FaxNumber: | 8013577927 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/03/2013 | ||||||||
| LastUpdateDate: | 04/03/2013 | ||||||||
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| AuthorizedOfficialLastName: | JUDD | ||||||||
| AuthorizedOfficialFirstName: | MICHELLE | ||||||||
| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | RESIDENCY COORDINATOR | ||||||||
| AuthorizedOfficialTelephone: | 8013577926 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | Y | ||||||||
| ParentOrganizationLBN: | INTERMOUNTAIN HEALTHCARE | ||||||||
| AuthorizedOfficialNamePrefix: | MRS. | ||||||||
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| AuthorizedOfficialCredential: | BS | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261QP2300X | Y | Ambulatory Health Care Facilities | Clinic/Center | Primary Care |
No ID Information.