Provider Demographics
NPI:1386404457
Name:WASATCH MEDICINE LLC
Entity type:Organization
Organization Name:WASATCH MEDICINE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:BENJAMIN
Authorized Official - Middle Name:REED
Authorized Official - Last Name:FOGG
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:801-712-2535
Mailing Address - Street 1:345 W 600 S STE 147
Mailing Address - Street 2:
Mailing Address - City:HEBER CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84032-2247
Mailing Address - Country:US
Mailing Address - Phone:801-712-2535
Mailing Address - Fax:
Practice Address - Street 1:345 W 600 S STE 147
Practice Address - Street 2:
Practice Address - City:HEBER CITY
Practice Address - State:UT
Practice Address - Zip Code:84032-2247
Practice Address - Country:US
Practice Address - Phone:801-712-2535
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-03-19
Last Update Date:2024-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care