Acqua Medical LLC
Family Medicine, Addiction Medicine in Midway, UT. Organization (NPI-2).
NPI number1427580448
StatusActive
Last updated in NPPESJun 20, 2018
Details
- NPI
- 1427580448
- Entity type
- Organization (NPI-2)
- Legal business name
- Acqua Medical LLC
- Organization subpart
- No
- Enumeration date
- Mar 29, 2017
- Last updated
- Jun 20, 2018
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 207QA0401X | Family Medicine, Addiction Medicine | 293281-1205 | UT | Yes |
| 2084A0401X | Psychiatry & Neurology, Addiction Medicine | – | – |
Practice location
100 N Johnson Mill RdMidway, UT 84049-6764
Phone 844-654-3700 · Fax 801-926-1133
Mailing address
1031 S Douglas StSalt Lake City, UT 84105-1505
Authorized official
Clint Tolman
Administrative Director
8446543700
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