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Organization
PROVIDENTIAL BBA OPERATING LP
Active
Organization
PROVIDENTIAL BBA OPERATING LP
Active
Other names
SDCH Physician Group
Organization subpart
No
Provider details
NPI number
Authorized official
MICHELLE BROWN CFO (CFO)
(801) 397-8145
Entity
Organization
Contact information
Practice address
401 S 400 E, BOUNTIFUL, UT 84010-4933
(801) 397-8145
(201) 294-5877
Mailing address
481 S 400 E, BOUNTIFUL, UT 84010-4933
(801) 397-8145
(801) 294-5877
Taxonomy
Speciality
Code
Description
License number
State
207RE0101X
Endocrinology, Diabetes & Metabolism Physician
—
—
207RH0002X
Hospice and Palliative Medicine (Internal Medicine) Physician
—
—
207RP1001X
Pulmonary Disease Physician
—
—
363L00000X
Nurse Practitioner
Primary
—
—
Other
Enumeration date
10/17/2023
Last updated
10/17/2023
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