CENTRIC PHYSICIANS INTERMOUNTAIN REGION, PLLC (NPI# 1467097071) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1467097071 |
| Entity Type | Organization |
| Organization Name | CENTRIC PHYSICIANS INTERMOUNTAIN REGION, PLLC |
| Practice Address |
7101 N Mesa Street #365 Salt Lake City UT 84101-1603 |
| Mailing Address |
113 Pleasant Valley Dr Ste 210 Boerne TX 78006-5683 |
| Practice Telephone | 8302674575 |
| Practice Fax Number | 8302674575 |
| Mailing Telephone | 8302674575 |
| Mailing Fax Number | 8302674575 |
| Enumeration Date | 2019-11-07 |
| Last Update Date | 2020-04-03 |
| Authorized Official Name | LAURA E. GIVENS (CEO) |
| Authorized Official Telephone | 8302674575 |
| Authorized Official Credential | MD |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 207Q00000X | Family Medicine | Allopathic & Osteopathic Physicians |
| Street Address |
7101 N MESA STREET #365 |
| City | SALT LAKE CITY |
| State | UT |
| Zip Code | 84101-1603 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1053804237 | Holly Smith | Registered Nurse | 1020 S Main Street, Salt Lake City, UT 84101 | 2018-06-12 |
| 1174999627 | Justin Williams | Social Worker | 155 W. 300 S., Salt Lake City, UT 84101 | 2015-08-19 |
| 1902291842 | Daryl Ray Ezidore | Student in an Organized Health Care Education/Training Program | 100 South 344 East, Salt Lake City, UT 84101 | 2015-03-30 |
| 1104190859 | Luxottica of America Inc. | Eyewear Supplier (Equipment, not the service) | 50 S Main St Ste 115, Salt Lake City, UT 84101 | 2012-02-28 |
| 1366713307 | Gonstead Family Chiropractic | Chiropractor | 1154 S. 300 W., Suite C, Salt Lake City, UT 84101 | 2012-01-23 |
| 1659544880 | Jeffrey Daniel | Registered Nurse | 404 South 400 West, Salt Lake City, UT 84101 | 2008-04-09 |
| 1306030580 | Christopher Dean Chapman | Chiropractor | 345 W 100 S Ste 6c, Salt Lake City, UT 84101 | 2007-08-30 |
| 1689713497 | Walter Landon Bye | Dentist | 15 West South Temple, Gateway Tower West Suite 440, Salt Lake City, UT 84101 | 2007-02-06 |
| 1154403152 | Allison Miller Gardner | Physical Therapist | 84 West 700 South, Salt Lake City, UT 84101 | 2006-10-19 |
| 1780655407 | Frederick Van Der Veur | Social Worker | 1020 South Main Street, 242, Salt Lake City, UT 84101 | 2006-01-30 |
| Find all providers in zip 84101 | ||||
| Taxonomy Code | 207Q00000X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Family Medicine |
| Family Medicine is the medical specialty which is concerned with the total health care of the individual and the family. It is the specialty in breadth which integrates the biological, clinical, and behavioral sciences. The scope of family medicine is not limited by age, sex, organ system, or disease entity. |
| Notes: Source: American Board of Family Medicine [1/1/2007: changed title; 7/1/2007: added definition, added source; 7/1/2017: modified definition] - Note: The American Osteopathic Board of Family Physicians certification includes extensive use of Osteopathic Manipulative Treatment (OMT), which integrates the biological, clinical, and behavioral sciences. - Additional Resources: American Board of Family Medicine, www.theabfm.org. American Osteopathic Board of Family Physicians, www.osteopathic.org/certification - Board certification for Medical Doctors (MDs) is provided by the American Board of Family Medicine. Board certification for Doctors of Osteopathy (DOs) is provided by the American Osteopathic Board of Family Physicians or the American Board of Family Medicine. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1356957468 | Aubrie Dawn Tilley | Family Medicine | 1741 E Imperial Park Ln, Salt Lake City, UT 84106-3379 | 2020-09-23 |
| 1457969834 | Sandra Lee Porter | Family Medicine | 3979 S Jester Dr, Salt Lake City, UT 84123-1227 | 2020-07-21 |
| 1265057673 | Onsite Care Clinics | Family Medicine | 230 S 500 E Ste 510, Salt Lake City, UT 84102-2028 | 2020-06-11 |
| 1760036024 | Mindy Marie Wade | Family Medicine | 1950 E Fort Union Blvd, Salt Lake City, UT 84121-6894 | 2019-07-25 |
| 1841854338 | Tandy Muse | Family Medicine | 4460 S Highland Dr Ste 400, Salt Lake City, UT 84124-3565 | 2019-04-30 |
| 1821561408 | Terra Bowden | Family Medicine | 450 S 900 E Ste 175, Salt Lake City, UT 84102-2981 | 2019-01-07 |
| 1801379193 | Country Corner Family Medicine | Family Medicine | 5460 W Clernates Dr, Salt Lake City, UT 84118-8526 | 2018-09-12 |
| 1396259008 | Futura Medical Clinic | Family Medicine | 1407 W North Temple Ste 120, Salt Lake City, UT 84116-3187 | 2017-11-17 |
| 1255858734 | Fjm Basecamp | Family Medicine | 185 S State St Ste 208, Salt Lake City, UT 84111-1558 | 2017-08-25 |
| 1427580174 | Lindsey Yanke | Family Medicine | 1365 South 1000 North, Salt Lake City, UT 84116-1654 | 2017-03-31 |
| Find all providers in SALT LAKE CITY | ||||
| City | SALT LAKE CITY |
| Zip Code | 84101 |
Please comment or provide details below to improve the information on CENTRIC PHYSICIANS INTERMOUNTAIN REGION, PLLC.
| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.