Organization
FJM OGDEN
Active
Other names
Onsite Care
Organization subpart
No
Provider details
NPI number
Authorized official
DARCE LATSIS (PROGRAM MANAGER)
(801) 441-1002
Entity
Organization
Contact information
Practice address
1104 COUNTRY HILLS DR, SUITE 110, OGDEN, UT 84403-2400
(801) 624-1633
Mailing address
560 S 300 E STE 275, SALT LAKE CITY, UT 84111-3586
(801) 441-1002
Taxonomy
Speciality
Code
Description
License number
State
261QP2300X
Primary Care Clinic/Center
Primary
94364441725
UT
Other
Enumeration date
06/23/2015
Last updated
01/30/2020
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