Organization
PROVIDENTIAL BBA OPERATING LP
Active
Other names
SDCH Physician Group
Organization subpart
No
Provider details
NPI number
Authorized official
MICHELLE BROWN CFO (CFO)
(801) 397-8145
Entity
Organization
Contact information
Practice address
401 S 400 E, BOUNTIFUL, UT 84010-4933
(801) 397-8145
(201) 294-5877
Mailing address
481 S 400 E, BOUNTIFUL, UT 84010-4933
(801) 397-8145
(801) 294-5877
Taxonomy
Speciality
Code
Description
License number
State
207RE0101X
Endocrinology, Diabetes & Metabolism Physician
—
—
207RH0002X
Hospice and Palliative Medicine (Internal Medicine) Physician
—
—
207RP1001X
Pulmonary Disease Physician
—
—
363L00000X
Nurse Practitioner
Primary
—
—
Other
Enumeration date
10/17/2023
Last updated
10/17/2023
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