Organization
MEDALLUS & VACHAROTHONE LTD
Active
Organization subpart
No
Provider details
NPI number
Authorized official
RACHOT VACHAROTHONE MD (CEO)
(801) 260-1919
Entity
Organization
Contact information
Practice address
721 1ST AVE S UNIT A, JAMESTOWN, ND 58401
(877) 633-9110
Mailing address
PO BOX 95970, SOUTH JORDAN, UT 84095-0970
(800) 877-9236
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
—
—
261QU0200X
Urgent Care Clinic/Center
—
—
363A00000X
Physician Assistant
—
—
363L00000X
Nurse Practitioner
—
—
Other
Enumeration date
09/26/2017
Last updated
07/24/2018
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