Provider Demographics
NPI:1366112922
Name:LIVING TREE URGENT CARE
Entity type:Organization
Organization Name:LIVING TREE URGENT CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL OFFICE COORDINATOR
Authorized Official - Prefix:
Authorized Official - First Name:KRIS
Authorized Official - Middle Name:
Authorized Official - Last Name:COLEMAN
Authorized Official - Suffix:
Authorized Official - Credentials:CPC,CMA
Authorized Official - Phone:435-770-2131
Mailing Address - Street 1:169 N GATEWAY DR STE 175
Mailing Address - Street 2:
Mailing Address - City:PROVIDENCE
Mailing Address - State:UT
Mailing Address - Zip Code:84332-9825
Mailing Address - Country:US
Mailing Address - Phone:435-565-6043
Mailing Address - Fax:
Practice Address - Street 1:169 N GATEWAY DR STE 175
Practice Address - Street 2:
Practice Address - City:PROVIDENCE
Practice Address - State:UT
Practice Address - Zip Code:84332-9825
Practice Address - Country:US
Practice Address - Phone:435-565-6043
Practice Address - Fax:435-220-2030
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:LIVING TREE MEDICAL GROUP
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2021-09-15
Last Update Date:2023-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QU0200XAmbulatory Health Care FacilitiesClinic/CenterUrgent Care