Organization
ACQUA MEDICAL LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
CLINT TOLMAN (ADMINISTRATIVE DIRECTOR)
(844) 654-3700
Entity
Organization
Contact information
Practice address
100 N JOHNSON MILL RD, MIDWAY, UT 84049-6764
(844) 654-3700
(801) 926-1133
Mailing address
1031 S DOUGLAS ST, SALT LAKE CITY, UT 84105-1505
Taxonomy
Speciality
Code
Description
License number
State
207QA0401X
Addiction Medicine (Family Medicine) Physician
Primary
293281-1205
UT
2084A0401X
Addiction Medicine (Psychiatry & Neurology) Physician
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Other
Enumeration date
03/29/2017
Last updated
06/20/2018
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