| Liberty Elementary | |
|
1078 S 300 E Salt Lake City UT 84111-4638 | |
| (801) 408-3585 | |
| Not Available |
| Full Name | Liberty Elementary |
|---|---|
| Speciality | Family Medicine |
| Location | 1078 S 300 E, Salt Lake City, Utah |
| Authorized Official Name and Position | Mark Briesacher (CHIEF PHYS EXEC/PRES MEDICAL GROUP) |
| Authorized Official Contact | 8014423495 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Liberty Elementary Po Box 27128 Salt Lake City UT 84127-0128 Ph: (801) 578-8376 | Liberty Elementary 1078 S 300 E Salt Lake City UT 84111-4638 Ph: (801) 408-3585 |
| NPI Number | 1659630457 |
|---|---|
| Provider Enumeration Date | 05/14/2012 |
| Last Update Date | 02/27/2018 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1659630457 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | 4562012 (Utah) | Primary |
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