Provider Demographics
NPI:1316349202
Name:HERITAGE VISITING PRACTITIONERS, LLC
Entity type:Organization
Organization Name:HERITAGE VISITING PRACTITIONERS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:ANDY
Authorized Official - Middle Name:H
Authorized Official - Last Name:PALMER
Authorized Official - Suffix:
Authorized Official - Credentials:MHA
Authorized Official - Phone:435-669-6970
Mailing Address - Street 1:150 N 1100 E UNIT 49
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:UT
Mailing Address - Zip Code:84780-2882
Mailing Address - Country:US
Mailing Address - Phone:435-669-6970
Mailing Address - Fax:
Practice Address - Street 1:150 N 1100 E UNIT 49
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:UT
Practice Address - Zip Code:84780-2882
Practice Address - Country:US
Practice Address - Phone:435-669-6970
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-09-22
Last Update Date:2014-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT14-135261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care