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Organization

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Active
Organization subpart
No

Provider details

NPI number
Authorized official
MS. MELINDA S ROALSTAD PAC (OWNER)
(435) 659-5932
Entity
Organization

Contact information

Practice address
1526 WEST UTE BLVD STE 110, PARK CITY, UT 84098
(435) 659-5932
(435) 258-6863
Mailing address
PO BOX 980983, PARK CITY, UT 84098
(435) 659-5932
(435) 258-6863

Taxonomy

Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary

Other

Enumeration date
07/12/2012
Last updated
10/11/2018
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