| Acqua Medical Llc | |
|
100 N Johnson Mill Rd Midway UT 84049-6764 | |
| (844) 654-3700 | |
| (801) 926-1133 |
| Full Name | Acqua Medical Llc |
|---|---|
| Speciality | Family Medicine - Addiction Medicine |
| Location | 100 N Johnson Mill Rd, Midway, Utah |
| Authorized Official Name and Position | Clint Tolman (ADMINISTRATIVE DIRECTOR) |
| Authorized Official Contact | 8446543700 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Acqua Medical Llc 1031 S Douglas St Salt Lake City UT 84105-1505 Ph: () - | Acqua Medical Llc 100 N Johnson Mill Rd Midway UT 84049-6764 Ph: (844) 654-3700 |
| NPI Number | 1427580448 |
|---|---|
| Provider Enumeration Date | 03/29/2017 |
| Last Update Date | 06/20/2018 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1427580448 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 2084A0401X | Psychiatry & Neurology - Addiction Medicine | (* (Not Available)) | Secondary |
| 207QA0401X | Family Medicine - Addiction Medicine | 293281-1205 (Utah) | Primary |