Provider Demographics
NPI:1194057703
Name:UTAH FERTILITY CENTER
Entity type:Organization
Organization Name:UTAH FERTILITY CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BUSINESS ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:GENIE
Authorized Official - Middle Name:T
Authorized Official - Last Name:ANDREWS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:208-342-5900
Mailing Address - Street 1:1988 W 930 N
Mailing Address - Street 2:SUITE B
Mailing Address - City:PLEASANT GROVE
Mailing Address - State:UT
Mailing Address - Zip Code:84062-4131
Mailing Address - Country:US
Mailing Address - Phone:801-492-9200
Mailing Address - Fax:801-492-3764
Practice Address - Street 1:1988 W 930 N
Practice Address - Street 2:SUITE B
Practice Address - City:PLEASANT GROVE
Practice Address - State:UT
Practice Address - Zip Code:84062-4131
Practice Address - Country:US
Practice Address - Phone:801-492-9200
Practice Address - Fax:801-492-3764
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-02-06
Last Update Date:2010-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT7509809-1205174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
1013014745OtherNPI
1265508493OtherNPI
1790734366OtherNPI