Organization
ASHLEY VALLEY PHYSICIAN PRACTICE LLC
Active
Parent organization
ASHLEY VALLEY PHYSICIAN PRACTICE LLC
Other names
ROOSEVELT COMMUNITY CLINIC
Organization subpart
Yes
Provider details
NPI number
Legal business name
ASHLEY VALLEY PHYSICIAN PRACTICE LLC
Authorized official
CHARLOTTE LAWRENCE (SECRETARY)
(615) 920-7000
Entity
Organization
Contact information
Practice address
409 S 200 E, ROOSEVELT, UT 84066-3314
(435) 781-0757
(435) 781-2628
Mailing address
409 S 200 E, ROOSEVELT, UT 84066-3314
(435) 781-0757
(435) 781-2628
Taxonomy
Speciality
Code
Description
License number
State
261QR1300X
Rural Health Clinic/Center
Primary
—
—
Other
Enumeration date
03/14/2013
Last updated
09/18/2024
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