| Wasatch Tech Iom Llc | |
|
10376 S Jordan Gtwy South Jordan UT 84095-3954 | |
| (801) 816-0332 | |
| (801) 816-0331 |
| Full Name | Wasatch Tech Iom Llc |
|---|---|
| Speciality | Psychiatry & Neurology - Neurology |
| Location | 10376 S Jordan Gtwy, South Jordan, Utah |
| Authorized Official Name and Position | Scott Frogley (OWNER/MBR) |
| Authorized Official Contact | 8018160332 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Wasatch Tech Iom Llc 10376 S Jordan Gtwy South Jordan UT 84095-3954 Ph: (801) 816-0332 | Wasatch Tech Iom Llc 10376 S Jordan Gtwy South Jordan UT 84095-3954 Ph: (801) 816-0332 |
| NPI Number | 1598430118 |
|---|---|
| Provider Enumeration Date | 08/16/2021 |
| Last Update Date | 08/16/2021 |
| Certification Date | 08/16/2021 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1598430118 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 2084N0400X | Psychiatry & Neurology - Neurology | (* (Not Available)) | Primary |
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