Organization
MOUNTAINSTAR MEDICAL GROUP- CACHE VALLEY, LLC
Active
Other names
MountainStar Cache Valley Medical Group
Organization subpart
No
Provider details
NPI number
Authorized official
LOUIS JOSEPH (VP)
(615) 373-7630
Entity
Organization
Contact information
Practice address
382 W 280 N, PROVIDENCE, UT 84332-9753
(435) 752-0330
(435) 755-0922
Mailing address
2000 HEALTH PARK DR, BRENTWOOD, TN 37027-4525
(615) 373-7600
(866) 346-1426
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1144475674
—
UT
Enumeration date
11/25/2008
Last updated
01/02/2023
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