| Pcmc Research Park | |
|
5770 S 1500 W Bldg C Salt Lake City UT 84123-5216 | |
| (801) 313-7770 | |
| (801) 313-7771 |
| Full Name | Pcmc Research Park |
|---|---|
| Speciality | Clinic/center - Adolescent And Children Mental Health |
| Location | 5770 S 1500 W, Salt Lake City, Utah |
| Authorized Official Name and Position | Christine J. Johnson (MANAGER, PROVIDER ENROLLMENT) |
| Authorized Official Contact | 8014423156 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Pcmc Research Park Po Box 27128 Salt Lake City UT 84127-0128 Ph: (801) 442-1400 | Pcmc Research Park 5770 S 1500 W Bldg C Salt Lake City UT 84123-5216 Ph: (801) 313-7770 |
| NPI Number | 1194840157 |
|---|---|
| Provider Enumeration Date | 03/20/2007 |
| Last Update Date | 12/03/2013 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1194840157 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QM0855X | Clinic/center - Adolescent And Children Mental Health | (* (Not Available)) | Primary |
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