Organization
PHYSICIAN HOME CARE OF UTAH,L.C.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. JOHN R DIETLEIN M.D. (MEDICAL DIRECTOR)
(801) 944-0095
Entity
Organization
Contact information
Practice address
6886 HOLLOW MILL DR, SALT LAKE CITY, UT 84121-3322
(801) 944-0095
Mailing address
PO BOX 712270, SALT LAKE CITY, UT 84171-2270
(801) 944-0095
Taxonomy
Speciality
Code
Description
License number
State
207QG0300X
Geriatric Medicine (Family Medicine) Physician
Primary
169963-1205
UT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
530429522033
—
UT
Enumeration date
09/23/2006
Last updated
10/19/2007
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