Organization
PARK CITY INTERNAL MEDICINE - PEDIATRICS, LC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
PENNY PEACOCK MD (OWNER)
(435) 655-3309
Entity
Organization
Contact information
Practice address
1612 UTE BLVD, STE 205, PARK CITY, UT 84098-7500
(435) 655-3309
(435) 655-3392
Mailing address
1612 UTE BLVD, STE 205, PARK CITY, UT 84098-7500
(435) 655-3309
(435) 655-3392
Taxonomy
Speciality
Code
Description
License number
State
261QH0100X
Health Service Clinic/Center
Primary
5151398-1205
UT
Other
Enumeration date
02/04/2008
Last updated
05/18/2011
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