# NORTHERN UTAH MEDICAL SUPPLY LLC

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- **Entity:** Organization
- **Status:** Active
- **Other names:** HP Medical Clinic
- **Organization subpart:** No

## Provider details

- **NPI number:** 1912649609
- **Authorized official:** JACOB BRUCE PUGSLEY DO (DO/OWNER)
- **Authorized official phone:** (435) 787-2000

## Contact information

- **Practice address:** 1030 S MEDICAL DR STE A, BRIGHAM CITY, UT 84302-3281
- **Practice address phone:** (435) 723-9700
- **Practice address fax:** (435) 723-9710
- **Mailing address:** 280 S MAIN ST, BOUNTIFUL, UT 84010-6236
- **Mailing address phone:** (801) 505-0821
- **Mailing address fax:** (801) 505-0803

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 208100000X | Physical Medicine & Rehabilitation Physician | — | NULL | Yes |
| 208100000X | Physical Medicine & Rehabilitation Physician | — | — | Yes |

## Other

- **Enumeration date:** 04/12/2022
- **Last updated:** 05/24/2023