| Live Well Center - Ogden | |
|
4421 Harrison Blvd Ste A6 Ogden UT 84403-3174 | |
| (801) 387-8400 | |
| Not Available |
| Full Name | Live Well Center - Ogden |
|---|---|
| Speciality | Internal Medicine - Sports Medicine |
| Location | 4421 Harrison Blvd Ste A6, Ogden, Utah |
| Authorized Official Name and Position | Mark Briesacher (SVP-CHIEF PHY EXECUTIVE) |
| Authorized Official Contact | 8014423495 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Live Well Center - Ogden Po Box 27128 Salt Lake City UT 84127-0128 Ph: (801) 387-8400 | Live Well Center - Ogden 4421 Harrison Blvd Ste A6 Ogden UT 84403-3174 Ph: (801) 387-8400 |
| NPI Number | 1619570694 |
|---|---|
| Provider Enumeration Date | 11/20/2020 |
| Last Update Date | 11/20/2020 |
| Certification Date | 11/20/2020 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1619570694 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207RS0010X | Internal Medicine - Sports Medicine | () | Primary |
| 2083X0100X | Preventive Medicine - Occupational Medicine | () | Secondary |
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