Provider Demographics
NPI:1548630908
Name:SMART MEDICAL, LLC
Entity type:Organization
Organization Name:SMART MEDICAL, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:RUSSELL
Authorized Official - Last Name:BROWN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:801-865-1884
Mailing Address - Street 1:6337 S HIGHLAND DR
Mailing Address - Street 2:STE 110
Mailing Address - City:HOLLADAY
Mailing Address - State:UT
Mailing Address - Zip Code:84121-2107
Mailing Address - Country:US
Mailing Address - Phone:801-865-1884
Mailing Address - Fax:801-386-9890
Practice Address - Street 1:6337 S HIGHLAND DR
Practice Address - Street 2:STE 110
Practice Address - City:SALT LAKE CITY
Practice Address - State:UT
Practice Address - Zip Code:84121-2107
Practice Address - Country:US
Practice Address - Phone:801-865-1884
Practice Address - Fax:801-386-9890
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-09-29
Last Update Date:2015-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT57788261QH0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service