Organization
UTAH DEPARTMENT OF HEALTH - HEALTH CLINICS OF UTAH
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JACOB JAMES FITISEMANU JR. (CLINIC MANAGER)
(801) 499-7544
Entity
Organization
Contact information
Practice address
2540 WASHINGTON BLVD, SUITE 122, OGDEN, UT 84401-3122
(801) 395-6401
Mailing address
2540 WASHINGTON BLVD, SUITE 122, OGDEN, UT 84401-3122
Taxonomy
Speciality
Code
Description
License number
State
251S00000X
Community/Behavioral Health Agency
Primary
—
—
Other
Enumeration date
11/21/2016
Last updated
11/21/2016
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