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Organization
RED TYDE
Active
Organization
RED TYDE
Active
Organization subpart
No
Provider details
NPI number
Authorized official
TIFFANY M REDMOND PA-C (OWNER)
(435) 213-3797
Entity
Organization
Contact information
Practice address
196 S 100 W, LOGAN, UT 84321-5233
(435) 938-1440
(833) 359-1642
Mailing address
280 S MAIN ST, BOUNTIFUL, UT 84010-6236
(801) 505-0821
(801) 505-0803
Taxonomy
Speciality
Code
Description
License number
State
261QM0801X
Mental Health Clinic/Center (Including Community Mental Health Center)
—
NULL
261QM0855X
Adolescent and Children Mental Health Clinic/Center
—
NULL
261QP2300X
Primary Care Clinic/Center
—
NULL
363AM0700X
Medical Physician Assistant
Primary
—
NULL
363AM0700X
Medical Physician Assistant
Primary
—
—
Other
Enumeration date
05/03/2021
Last updated
10/15/2026
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