Stat-MD I
Clinic/Center, Primary Care in Park City, UT. Organization (NPI-2).
NPI number1164063277
StatusActive
Last updated in NPPESOct 1, 2019
Details
- NPI
- 1164063277
- Entity type
- Organization (NPI-2)
- Legal business name
- Stat-MD I
- Organization subpart
- No
- Enumeration date
- Oct 1, 2019
- Last updated
- Oct 1, 2019
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 261QP2300X | Clinic/Center, Primary Care | – | – | Yes |
| 207R00000X | Internal Medicine | – | – |
Practice location
1784 Uinta Way Unit E2Park City, UT 84098-7685
Phone 435-604-0160 · Fax 435-731-8328
Mailing address
Po Box 981630Park City, UT 84098-1630
Phone 435-604-0160 · Fax 435-604-0160
Authorized official
Bryan Knepper
Owner
4356040160
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