| Shadow Mountain Family Medicine Llc | |
|
3855 W 7800 S Suite 100 West Jordan UT 84088-5560 | |
| (801) 282-5952 | |
| (801) 282-5951 |
| Full Name | Shadow Mountain Family Medicine Llc |
|---|---|
| Speciality | Family Medicine |
| Location | 3855 W 7800 S, West Jordan, Utah |
| Authorized Official Name and Position | David J. Kane (VP) |
| Authorized Official Contact | 8015685999 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Shadow Mountain Family Medicine Llc 3855 W 7800 S Suite 100 West Jordan UT 84088-5560 Ph: (801) 282-5952 | Shadow Mountain Family Medicine Llc 3855 W 7800 S Suite 100 West Jordan UT 84088-5560 Ph: (801) 282-5952 |
| NPI Number | 1225294697 |
|---|---|
| Provider Enumeration Date | 08/05/2008 |
| Last Update Date | 06/04/2009 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1225294697 | NPI | - | NPPES |
| 1225294697 | Medicaid | UT |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | (* (Not Available)) | Primary |
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