WASATCH OPTIMAL WELLNESS CLINIC LLC NPI 1508619040

NPI Information

  • NPI: 1508619040
  • Provider Name: WASATCH OPTIMAL WELLNESS CLINIC LLC
  • Classification: Clinic/Center - 261QH0100X
  • Specialization: Health Service
  • Entity Type: Organization
  • CLIA Number: 46D2307666
  • Address: 1716 N HIGHWAY 40 STE 200
    HEBER CITY, UT
    ZIP 84032
  • Phone: (435) 800-6969

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NPI Details

WASATCH OPTIMAL WELLNESS CLINIC LLC is a health service clinic center in Heber City, UT. WASATCH OPTIMAL WELLNESS CLINIC LLC NPI is 1508619040. The provider is registered as an organization entity type.

The provider's business location address is:

1716 N HIGHWAY 40 STE 200
HEBER CITY, UT
ZIP 84032-677
Phone: (435) 800-6969

The provider's authorized official is Benjamin Fogg .
The authorized official title is Medical Director / Coo and has the following contact phone number (435) 800-6969.

The CLIA number assigned to this NPI record is 46D2307666 - community clinic with a certificate type of Certificate of Waiver.

The enumeration date for this NPI number is 4/5/2024 and was last updated on 9/22/2025.

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
1261QH0100XClinic/CenterHealth ServiceYes

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: 11/21/2025

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