| Midtown South Salt Lake Chc | |
|
2253 S State St Salt Lake City UT 84115-2752 | |
| (801) 393-5355 | |
| (801) 394-4609 |
| Full Name | Midtown South Salt Lake Chc |
|---|---|
| Speciality | Clinic/Center |
| Location | 2253 S State St, Salt Lake City, Utah |
| Authorized Official Name and Position | Sonja Levesque (CFO) |
| Authorized Official Contact | 8013341327 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Midtown South Salt Lake Chc 2240 Adams Ave Ogden UT 84401-1511 Ph: (801) 393-5355 | Midtown South Salt Lake Chc 2253 S State St Salt Lake City UT 84115-2752 Ph: (801) 393-5355 |
| NPI Number | 1033547567 |
|---|---|
| Provider Enumeration Date | 10/18/2013 |
| Last Update Date | 10/18/2013 |
| Medicare PECOS PAC ID | 0345135414 |
|---|---|
| Medicare Enrollment ID | O20131211001264 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1033547567 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QC1500X | Clinic/center - Community Health | (* (Not Available)) | Secondary |
| 261QF0400X | Clinic/center - Federally Qualified Health Center (fqhc) | (* (Not Available)) | Primary |
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