Organization
PRIMARY HEALTHCARE, PLLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
KEVIN MANGUM DO (CEO/PHYSICIAN)
(801) 758-8735
Entity
Organization
Contact information
Practice address
6095 S FASHION BLVD STE 220, MURRAY, UT 84107-7393
(801) 758-8735
(801) 769-3991
Mailing address
6095 S FASHION BLVD STE 220, MURRAY, UT 84107-7393
(801) 758-8735
(801) 769-3991
Taxonomy
Speciality
Code
Description
License number
State
207QS0010X
Sports Medicine (Family Medicine) Physician
—
—
207XX0005X
Sports Medicine (Orthopaedic Surgery) Physician
—
—
261QM1300X
Multi-Specialty Clinic/Center
—
—
261QM2500X
Medical Specialty Clinic/Center
—
—
261QP2000X
Physical Therapy Clinic/Center
—
—
261QP2300X
Primary Care Clinic/Center
Primary
—
—
261QU0200X
Urgent Care Clinic/Center
—
—
Other
Enumeration date
10/26/2022
Last updated
06/02/2023
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