Provider Demographics
NPI:1174787196
Name:ATM COUNSELING & MEDICAL SERVICES
Entity type:Organization
Organization Name:ATM COUNSELING & MEDICAL SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:SEAN
Authorized Official - Middle Name:A
Authorized Official - Last Name:PONCE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:801-562-0806
Mailing Address - Street 1:555 E 4500 S
Mailing Address - Street 2:C-150
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84107-4533
Mailing Address - Country:US
Mailing Address - Phone:801-288-0747
Mailing Address - Fax:801-288-0761
Practice Address - Street 1:7370 CREEK RD
Practice Address - Street 2:101
Practice Address - City:SANDY
Practice Address - State:UT
Practice Address - Zip Code:84093-6105
Practice Address - Country:US
Practice Address - Phone:801-562-0806
Practice Address - Fax:801-562-0807
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ATM COUNSELING & MEDICAL SERVICES
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2008-07-18
Last Update Date:2008-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT4976571-1205174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT000059207Medicare PIN
UTH52035Medicare UPIN