# MOUNTAINSTAR MEDICAL GROUP TIMPANOGOS SPECIALTY CARE, LLC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1184090870
- **Authorized official:** WILLIAM TEDRICK JOHNSON (GROUP VP/AO)
- **Authorized official phone:** (615) 372-3375

## Contact information

- **Practice address:** 1020 S 1100 W STE B, LEHI, UT 84043-6041
- **Practice address phone:** (801) 653-2757
- **Practice address fax:** (801) 653-2747
- **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 |
| --- | --- | --- | --- | --- |
| 207V00000X | Obstetrics & Gynecology Physician | — | NULL | Yes |
| 207V00000X | Obstetrics & Gynecology Physician | — | — | Yes |

## Other

- **Enumeration date:** 08/17/2015
- **Last updated:** 10/28/2020