Provider Demographics
NPI:1457160376
Name:MOSERTI LLC
Entity type:Organization
Organization Name:MOSERTI LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CEO, OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:MATTHEW
Authorized Official - Middle Name:MICHAEL
Authorized Official - Last Name:HILL
Authorized Official - Suffix:
Authorized Official - Credentials:PA-C
Authorized Official - Phone:435-227-5371
Mailing Address - Street 1:3105 S 225 W # A102
Mailing Address - Street 2:
Mailing Address - City:NIBLEY
Mailing Address - State:UT
Mailing Address - Zip Code:84321-7067
Mailing Address - Country:US
Mailing Address - Phone:385-222-8368
Mailing Address - Fax:385-900-1612
Practice Address - Street 1:169 N GATEWAY DR STE 130
Practice Address - Street 2:
Practice Address - City:PROVIDENCE
Practice Address - State:UT
Practice Address - Zip Code:84332-9737
Practice Address - Country:US
Practice Address - Phone:435-227-5371
Practice Address - Fax:385-900-1612
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-01-06
Last Update Date:2025-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
No261Q00000XAmbulatory Health Care FacilitiesClinic/CenterGroup - Single Specialty