Provider Demographics
NPI:1902311558
Name:UCFA PHYSICIANS NETWORK GROUP OF UT
Entity type:Organization
Organization Name:UCFA PHYSICIANS NETWORK GROUP OF UT
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CHIEF OPERATIONS OFFICER
Authorized Official - Prefix:MR
Authorized Official - First Name:THEO
Authorized Official - Middle Name:S
Authorized Official - Last Name:STEPHENS
Authorized Official - Suffix:
Authorized Official - Credentials:CMA
Authorized Official - Phone:423-271-9911
Mailing Address - Street 1:8930 CROSS PARK DR STE 3
Mailing Address - Street 2:
Mailing Address - City:KNOXVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37923-4713
Mailing Address - Country:US
Mailing Address - Phone:423-271-9911
Mailing Address - Fax:
Practice Address - Street 1:159 W BROADWAY
Practice Address - Street 2:
Practice Address - City:SALT LAKE CITY
Practice Address - State:UT
Practice Address - Zip Code:84101-1907
Practice Address - Country:US
Practice Address - Phone:865-307-3441
Practice Address - Fax:865-409-2526
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-12-05
Last Update Date:2021-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty