Organization
PHYSICIAN GROUP OF UTAH INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
ASHLEY KOCH (CFO)
(617) 562-7070
Entity
Organization
Contact information
Practice address
406 W SOUTH JORDAN PKWY, SUITE 500, SOUTH JORDAN, UT 84095-3965
(801) 984-3418
(801) 984-3479
Mailing address
PO BOX 281415, ATLANTA, GA 30384-1415
(800) 673-1270
(314) 432-9683
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1477676930
—
UT
Enumeration date
04/09/2007
Last updated
03/06/2020
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