Organization
UNIVERSITY PRIMARY CARE SPORTS MED
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. MICHAEL K MAGILL MD (DEPARTMENT CHAIR)
(801) 585-5382
Entity
Organization
Contact information
Practice address
555 FOOTHILL DR, SALT LAKE CITY, UT 84112-1106
(801) 585-5382
Mailing address
PO BOX 510004, SALT LAKE CITY, UT 84151-0004
(801) 587-6303
Taxonomy
Speciality
Code
Description
License number
State
207QS0010X
Sports Medicine (Family Medicine) Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
100510167
NEVADA MEDICAID
NV
01
—
123613000
WYOMING MEDICAID
WY
01
—
807551900
IDAHO MEDICAID
ID
01
—
DG1456
RAILROAD MEDICARE
UT
Enumeration date
07/22/2006
Last updated
09/06/2011
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