# MOUNTAINSTAR MEDICAL GROUP- CACHE VALLEY, LLC

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- **Entity:** Organization
- **Status:** Active
- **Other names:** MountainStar Cache Valley Medical Group
- **Organization subpart:** No

## Provider details

- **NPI number:** 1144475674
- **Authorized official:** LOUIS JOSEPH (VP)
- **Authorized official phone:** (615) 373-7630

## Contact information

- **Practice address:** 382 W 280 N, PROVIDENCE, UT 84332-9753
- **Practice address phone:** (435) 752-0330
- **Practice address fax:** (435) 755-0922
- **Mailing address:** 2000 HEALTH PARK DR, BRENTWOOD, TN 37027-4525
- **Mailing address phone:** (615) 373-7600
- **Mailing address fax:** (866) 346-1426

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207Q00000X | Family Medicine Physician | — | NULL | Yes |
| 207Q00000X | Family Medicine Physician | — | — | Yes |

## Other

- **Enumeration date:** 11/25/2008
- **Last updated:** 01/02/2023