Organization
NORTHEASTERN UTAH MEDICAL GROUP
Active
Organization subpart
No
Provider details
NPI number
Authorized official
BRENT H HALES (CFO)
(435) 722-6164
Entity
Organization
Contact information
Practice address
210 W 300 N, ROOSEVELT, UT 84066-2336
(435) 722-3971
(435) 722-6104
Mailing address
210 W 300 N, ROOSEVELT, UT 84066-2336
(435) 722-3971
(435) 722-6104
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
Primary
—
—
Other
Enumeration date
05/31/2007
Last updated
10/23/2025
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