Provider Demographics
NPI:1215130182
Name:SALT LAKE WOMEN'S CENTER
Entity type:Organization
Organization Name:SALT LAKE WOMEN'S CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:LAMAR
Authorized Official - Last Name:TWEDE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:801-561-3922
Mailing Address - Street 1:10011 CENTENNIAL PKWY
Mailing Address - Street 2:SUITE 350
Mailing Address - City:SANDY
Mailing Address - State:UT
Mailing Address - Zip Code:84070-4156
Mailing Address - Country:US
Mailing Address - Phone:801-561-3922
Mailing Address - Fax:801-569-8710
Practice Address - Street 1:10011 CENTENNIAL PKWY
Practice Address - Street 2:SUITE 350
Practice Address - City:SANDY
Practice Address - State:UT
Practice Address - Zip Code:84070-4156
Practice Address - Country:US
Practice Address - Phone:801-561-3922
Practice Address - Fax:801-569-8710
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-07
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT181357-1205174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT576727491009Medicaid
UT576727491009Medicaid
UTF29976Medicare UPIN