Provider Demographics
NPI:1942733415
Name:UTAH PODIATRY GROUP PC
Entity type:Organization
Organization Name:UTAH PODIATRY GROUP PC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:DPM
Authorized Official - Prefix:
Authorized Official - First Name:JARED
Authorized Official - Middle Name:DEE
Authorized Official - Last Name:MCPHIE
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:801-373-2499
Mailing Address - Street 1:PO BOX 30015
Mailing Address - Street 2:
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84130-0015
Mailing Address - Country:US
Mailing Address - Phone:801-451-6060
Mailing Address - Fax:801-797-9154
Practice Address - Street 1:345 W 600 S
Practice Address - Street 2:STE 408
Practice Address - City:HEBER CITY
Practice Address - State:UT
Practice Address - Zip Code:84032-2247
Practice Address - Country:US
Practice Address - Phone:801-373-2499
Practice Address - Fax:801-373-5200
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-04-11
Last Update Date:2025-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Multi-Specialty
No213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Multi-Specialty
No332B00000XSuppliersDurable Medical Equipment & Medical SuppliesGroup - Multi-Specialty