Organization
TOOELE CLINIC CORPORATION
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. MICHAELE PORTACCI (SENIOR GROUP VP)
(615) 309-3340
Entity
Organization
Contact information
Practice address
330 FRANKLIN RD #135A-304, BRENTWOOD, TN 37027-3280
(615) 309-3338
Mailing address
330 FRANKLIN RD, BRENTWOOD, TN 37027-3280
(615) 309-3338
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
87063588
UT
Other
Enumeration date
06/01/2005
Last updated
08/22/2020
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