Provider Demographics
NPI:1487375473
Name:NUMED CLINIC
Entity type:Organization
Organization Name:NUMED CLINIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ENKHYOUN
Authorized Official - Middle Name:
Authorized Official - Last Name:NERGUI
Authorized Official - Suffix:
Authorized Official - Credentials:DNP
Authorized Official - Phone:801-830-4305
Mailing Address - Street 1:1429 S STATE ST
Mailing Address - Street 2:
Mailing Address - City:OREM
Mailing Address - State:UT
Mailing Address - Zip Code:84097-7703
Mailing Address - Country:US
Mailing Address - Phone:801-830-4305
Mailing Address - Fax:
Practice Address - Street 1:1429 S STATE ST
Practice Address - Street 2:
Practice Address - City:OREM
Practice Address - State:UT
Practice Address - Zip Code:84097-7703
Practice Address - Country:US
Practice Address - Phone:801-830-4305
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-09-07
Last Update Date:2022-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
No261Q00000XAmbulatory Health Care FacilitiesClinic/CenterGroup - Multi-Specialty
No261QC1500XAmbulatory Health Care FacilitiesClinic/CenterCommunity Health
No261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service
No261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT1346812021Medicaid
UT1568037182Medicaid