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COMPREHENSIVE FAMILY CLINIC NPI 1528204922


NPI Information

NPI: 1528204922
Provider Name: COMPREHENSIVE FAMILY CLINIC

Doing Business As: LAKESIDE MEDICAL

Classification: General Practice - 208D00000X
Entity Type: Organization

CLIA Number: 05D2257799

Address:
4701 W 2100 S
BUILDING 3
SALT LAKE CITY, UT
ZIP 84120
Phone: (801) 974-3382
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COMPREHENSIVE FAMILY CLINIC is a general practice in Salt Lake City, UT. The provider is a physician who specializes in the general practice of diagnosing, treating, and managing patients with a variety of illnesses and conditions. Source: National Uniform Claim Committee COMPREHENSIVE FAMILY CLINIC NPI is 1528204922. The provider is registered as an organization entity type and is a multi-specialty group.
The provider Is Doing Business As Lakeside Medical.

The provider's business location address is:

4701 W 2100 S
BUILDING 3
SALT LAKE CITY, UT
ZIP 84120-223
Phone: (801) 974-3382
Fax: (801) 974-3295

The provider's authorized official is Erik Moll .
The authorized official title is Medical Director and has the following contact phone number (801) 974-3382.

The CLIA number assigned to this NPI record is 05D2257799 - school/student health service with a certificate type of Certificate of Waiver.

The enumeration date for this NPI number is 1/6/2009 and was last updated on 1/7/2009.


Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No.Taxonomy CodeTaxonomy ClasificationTaxonomy SpecializationLicense NumberLicense StatePrimary
1111N00000XChiropractor6787397-1202UTAHNo
2208D00000XGeneral Practice151129-1205UTAHYes

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 4/28/2024

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