Provider Demographics
NPI:1386344620
Name:OREM MEDICAL PROPERTIES LLC
Entity type:Organization
Organization Name:OREM MEDICAL PROPERTIES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:
Authorized Official - First Name:ABRAHAM
Authorized Official - Middle Name:
Authorized Official - Last Name:TOMCO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:435-503-1022
Mailing Address - Street 1:1500 E LIBERTY LN
Mailing Address - Street 2:
Mailing Address - City:HEBER CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84032-3583
Mailing Address - Country:US
Mailing Address - Phone:435-503-1022
Mailing Address - Fax:
Practice Address - Street 1:1350 E 750 N
Practice Address - Street 2:
Practice Address - City:OREM
Practice Address - State:UT
Practice Address - Zip Code:84097-4345
Practice Address - Country:US
Practice Address - Phone:801-852-2273
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-03-06
Last Update Date:2023-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT1033320791Medicaid