Provider Demographics
NPI:1154485951
Name:EAGLE MOUNTAIN FAMILY MEDICINE
Entity type:Organization
Organization Name:EAGLE MOUNTAIN FAMILY MEDICINE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:KAREEN
Authorized Official - Middle Name:
Authorized Official - Last Name:ALTON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:801-766-2121
Mailing Address - Street 1:1305 N COMMERCE DR
Mailing Address - Street 2:
Mailing Address - City:SARATOGA SPRINGS
Mailing Address - State:UT
Mailing Address - Zip Code:84043-5305
Mailing Address - Country:US
Mailing Address - Phone:801-766-2121
Mailing Address - Fax:
Practice Address - Street 1:1305 N COMMERCE DR
Practice Address - Street 2:
Practice Address - City:SARATOGA SPRINGS
Practice Address - State:UT
Practice Address - Zip Code:84043-5305
Practice Address - Country:US
Practice Address - Phone:801-766-2121
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-19
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes173000000XOther Service ProvidersLegal MedicineGroup - Single Specialty