Organization
MOUNTAINSTAR MEDICAL GROUP TIMPANOGOS SPECIALTY CARE, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
WILLIAM TEDRICK JOHNSON (GROUP VP/AO)
(615) 372-3375
Entity
Organization
Contact information
Practice address
1020 S 1100 W STE B, LEHI, UT 84043-6041
(801) 653-2757
(801) 653-2747
Mailing address
2000 HEALTH PARK DR, BRENTWOOD, TN 37027-4525
(615) 373-7600
(866) 346-1426
Taxonomy
Speciality
Code
Description
License number
State
207V00000X
Obstetrics & Gynecology Physician
Primary
—
—
Other
Enumeration date
08/17/2015
Last updated
10/28/2020
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