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Organization
TRIVIVIA MEDICAL LLC
Active
Organization
TRIVIVIA MEDICAL LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. SAMUEL BRIAN WILKINSON (OWNER)
(808) 782-6761
Entity
Organization
Contact information
Practice address
2901 W BLUE GRASS BLVD, LEHI, UT 84043-4188
(808) 782-6761
Mailing address
2901 W BLUE GRASS BLVD, LEHI, UT 84043-4188
(808) 782-6761
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
—
NULL
207P00000X
Emergency Medicine Physician
—
—
207Q00000X
Family Medicine Physician
Primary
—
NULL
207Q00000X
Family Medicine Physician
Primary
—
—
207R00000X
Internal Medicine Physician
—
NULL
207R00000X
Internal Medicine Physician
—
—
261Q00000X
Clinic/Center
—
NULL
261QA1903X
Ambulatory Surgical Clinic/Center
—
NULL
261QC1500X
Community Health Clinic/Center
—
NULL
261QC1800X
Corporate Health Clinic/Center
—
NULL
261QI0500X
Infusion Therapy Clinic/Center
—
NULL
261QM1300X
Multi-Specialty Clinic/Center
—
NULL
261QP1100X
Podiatric Clinic/Center
—
NULL
261QP2300X
Primary Care Clinic/Center
—
NULL
261QP3300X
Pain Clinic/Center
—
NULL
261QR0208X
Mobile Radiology Clinic/Center
—
NULL
261QU0200X
Urgent Care Clinic/Center
—
NULL
Other
Enumeration date
07/17/2020
Last updated
08/31/2020
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