Organization
SOUTHWEST CHILDREN'S CLINIC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. JILL PHILLIPS (OFFICE MANAGER)
(801) 593-1975
Entity
Organization
Contact information
Practice address
8822 SO REDWOOD RD, C211, WEST JORDAN, UT 84088-8811
(801) 563-1975
(801) 563-1984
Mailing address
8822 REDWOOD RD STE C211, WEST JORDAN, UT 84088-9336
(801) 563-1975
(801) 563-1984
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
319791-1205
UT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
07027
—
UT
05
—
D1713
—
UT
05
—
D3859
—
UT
05
—
D5092
—
UT
Enumeration date
03/20/2007
Last updated
08/22/2020
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