Basic Information
| Provider Information | |||||||||
| NPI: | 1932490190 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | WORK CARE CLINIC | ||||||||
| LastName: | |||||||||
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| OtherOrganizationName: | |||||||||
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| Mailing Information | |||||||||
| Address1: | 2390 S REDWOOD ROAD | ||||||||
| Address2: | |||||||||
| City: | SALT LAKE CITY | ||||||||
| State: | UT | ||||||||
| PostalCode: | 841192027 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8019751600 | ||||||||
| FaxNumber: | 8019782693 | ||||||||
| Practice Location | |||||||||
| Address1: | 2390 S REDWOOD ROAD | ||||||||
| Address2: | |||||||||
| City: | SALT LAKE CITY | ||||||||
| State: | UT | ||||||||
| PostalCode: | 841192027 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8019751600 | ||||||||
| FaxNumber: | 8019782693 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/22/2011 | ||||||||
| LastUpdateDate: | 04/22/2011 | ||||||||
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| ProviderGenderCode: | |||||||||
| AuthorizedOfficialLastName: | ANDERSON | ||||||||
| AuthorizedOfficialFirstName: | MARK | ||||||||
| AuthorizedOfficialMiddleName: | V | ||||||||
| AuthorizedOfficialTitleorPosition: | PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 8019751600 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
| ParentOrganizationLBN: | |||||||||
| AuthorizedOfficialNamePrefix: | MR. | ||||||||
| AuthorizedOfficialNameSuffix: | |||||||||
| 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.