# TRIVIVIA MEDICAL LLC

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

## Provider details

- **NPI number:** 1730797598
- **Authorized official:** MR. SAMUEL BRIAN WILKINSON (OWNER)
- **Authorized official phone:** (808) 782-6761

## Contact information

- **Practice address:** 2901 W BLUE GRASS BLVD, LEHI, UT 84043-4188
- **Practice address phone:** (808) 782-6761
- **Mailing address:** 2901 W BLUE GRASS BLVD, LEHI, UT 84043-4188
- **Mailing address phone:** (808) 782-6761

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207P00000X | Emergency Medicine Physician | — | NULL | — |
| 207P00000X | Emergency Medicine Physician | — | — | — |
| 207Q00000X | Family Medicine Physician | — | NULL | Yes |
| 207Q00000X | Family Medicine Physician | — | — | Yes |
| 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