Organization
HEALTH DIVERSIFIED - MEDICAL GROUP OF UTAH
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. ANN SMITH (AUTHORIZED OFFICIAL)
(801) 682-6817
Entity
Organization
Contact information
Practice address
4544 S HOLLADAY BLVD, HOLLADAY, UT 84117-4404
(801) 682-6817
(385) 213-0356
Mailing address
5986 S TOLCATE WOODS LN, HOLLADAY, UT 84121-1536
(801) 682-6817
(385) 213-0356
Taxonomy
Speciality
Code
Description
License number
State
103TC1900X
Counseling Psychologist
—
—
1041C0700X
Clinical Social Worker
—
—
133V00000X
Registered Dietitian
—
—
207P00000X
Emergency Medicine Physician
—
—
207Q00000X
Family Medicine Physician
—
—
207R00000X
Internal Medicine Physician
—
—
207SG0201X
Clinical Genetics (M.D.) Physician
—
—
207V00000X
Obstetrics & Gynecology Physician
—
—
208000000X
Pediatrics Physician
—
—
225100000X
Physical Therapist
—
—
251B00000X
Case Management Agency
—
—
261QC1800X
Corporate Health Clinic/Center
—
—
261QM1300X
Multi-Specialty Clinic/Center
Primary
—
—
363A00000X
Physician Assistant
—
—
363L00000X
Nurse Practitioner
—
—
Other
Enumeration date
01/25/2022
Last updated
03/06/2026
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