Organization
IN HOME PROVIDER
Active
Organization subpart
No
Provider details
NPI number
Authorized official
SHANE WHITTIER (COO)
(435) 709-8786
Entity
Organization
Contact information
Practice address
2432 CONCORD AVE, SANTA CLARA, UT 84765-5621
(435) 659-7352
Mailing address
387 W 100 S, HEBER CITY, UT 84032-1835
(435) 671-3285
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
—
—
Other
Enumeration date
12/11/2019
Last updated
12/11/2019
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