LIFE ELEVATED FAMILY MEDICINE & COUNSELING LLC NPI 1366114944

NPI Information

NPI: 1366114944
Provider Name: LIFE ELEVATED FAMILY MEDICINE & COUNSELING LLC
Classification: Clinic/Center - 261QM1300X
Entity Type: Organization

Specialization: Multi-Specialty

Address:
3686 W. 2100 S.
SALT LAKE CITY, UT
ZIP 84120
Phone: (435) 830-0554
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LIFE ELEVATED FAMILY MEDICINE & COUNSELING LLC is a multi-specialty clinic center in Salt Lake City, UT. LIFE ELEVATED FAMILY MEDICINE & COUNSELING LLC NPI is 1366114944. The provider is registered as an organization entity type.

The provider's business location address is:

3686 W. 2100 S.
SALT LAKE CITY, UT
ZIP 84120-412
Phone: (435) 830-0554
Fax: (385) 247-8023

The provider's authorized official is Brock Dan Haskell .
The authorized official title is Pa/owner and has the following contact phone number (435) 830-0554.

The enumeration date for this NPI number is 10/1/2021 and was last updated on 10/1/2021.

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 Code	Taxonomy Clasification	Taxonomy Specialization	License Number	License State	Primary
1	261QM1300X	Clinic/Center	Multi-Specialty			Yes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No.	Other Provider Identifier	Other Provider Identifier Type	Other Provider Identifier State	Other Provider Identifier Issuer
1	118561179-1206	OTHER	UTAH	LICENSE

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

NPI Synchronization or Removal

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