# ASHLEY VALLEY PHYSICIAN PRACTICE, LLC

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- **Entity:** Organization
- **Status:** Active
- **Other names:** Roosevelt Community Clinic
- **Organization subpart:** No

## Provider details

- **NPI number:** 1518247709
- **Authorized official:** CHARLOTTE LAWRENCE (SECRETARY)
- **Authorized official phone:** (615) 920-7000

## Contact information

- **Practice address:** 409 S 200 E, ROOSEVELT, UT 84066-3314
- **Practice address phone:** (435) 725-3327
- **Practice address fax:** (435) 725-3331
- **Mailing address:** 409 S 200 E, ROOSEVELT, UT 84066-3314
- **Mailing address phone:** (435) 725-3327
- **Mailing address fax:** (435) 725-3331

## Taxonomy

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

## Other

- **Enumeration date:** 08/19/2011
- **Last updated:** 09/18/2024