Provider Demographics
NPI:1598508368
Name:ATLAS INTEGRATED MEDICINE
Entity type:Organization
Organization Name:ATLAS INTEGRATED MEDICINE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:
Authorized Official - Last Name:BUNN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:801-689-2592
Mailing Address - Street 1:1496 E 5600 S STE 6
Mailing Address - Street 2:
Mailing Address - City:SOUTH OGDEN
Mailing Address - State:UT
Mailing Address - Zip Code:84403-4824
Mailing Address - Country:US
Mailing Address - Phone:801-689-2592
Mailing Address - Fax:
Practice Address - Street 1:1496 E 5600 S STE 6
Practice Address - Street 2:
Practice Address - City:SOUTH OGDEN
Practice Address - State:UT
Practice Address - Zip Code:84403-4824
Practice Address - Country:US
Practice Address - Phone:801-689-2592
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-06-18
Last Update Date:2024-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGroup - Multi-Specialty