Organization
WESTERN NEUROLOGICAL ASSOCIATES INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MICHELLE LYNN HINES (BUSINESS OFFICE)
(801) 262-3441
Entity
Organization
Contact information
Practice address
1151 E 3900 S, #B150, SALT LAKE CITY, UT 84124-1216
(801) 262-3441
(801) 269-9005
Mailing address
1151 E 3900 S, #B150, SALT LAKE CITY, UT 84124-1216
(801) 262-3441
(801) 269-9005
Taxonomy
Speciality
Code
Description
License number
State
103T00000X
Psychologist
—
—
2084N0400X
Neurology Physician
Primary
—
UT
2084N0402X
Neurology with Special Qualifications in Child Neurology Physician
—
UT
2085R0202X
Diagnostic Radiology Physician
0055926
UT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
00055926
MEDICARE PTAN
UT
05
—
870446965007
—
UT
Enumeration date
07/07/2005
Last updated
07/21/2022
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