# SHADOW MOUNTAIN FAMILY MEDICINE LLC

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

## Provider details

- **NPI number:** 1225294697
- **Authorized official:** DAVID J. KANE (VP)
- **Authorized official phone:** (801) 568-5999

## Contact information

- **Practice address:** 3855 W 7800 S, SUITE 100, WEST JORDAN, UT 84088-5560
- **Practice address phone:** (801) 282-5952
- **Practice address fax:** (801) 282-5951
- **Mailing address:** 3855 W 7800 S, SUITE 100, WEST JORDAN, UT 84088-5560
- **Mailing address phone:** (801) 282-5952
- **Mailing address fax:** (801) 282-5951

## Taxonomy

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

## Other

- **Enumeration date:** 08/05/2008
- **Last updated:** 06/04/2009