3 Form - West Valley City

LBN: Premise Health Of Utah Medical, P.C
3 Form - West Valley City is an health care organization with primary practice located at 2300 S 2300 W Ste B , West Valley City UT 84119-2022. The organization recently has only one registered license in Ambulatory Health Care Facilities / Multi-Specialty, which is considered as the primary health care specialty. Premise Health Of Utah Medical, P.C can be contacted via phone (801) 975-7505, or through Leizman, Jon via phone (216) 479-9063.

Contact Information

Primary practice address
2300 S 2300 W Ste B West Valley City UT 84119-2022
Phone: (801) 975-7505
Fax:
Website:
Map and Directions
Authorized official contact:
Name: Leizman, Jon
Phone: (216) 479-9063

Health care specialties

SpecialtyCodeLicense #State
Ambulatory Health Care Facilities / Multi-Specialty 261QM1300X

Profile Details

NPI number 1093488926
LBN Legal business name Premise Health Of Utah Medical, P.C
DBA Doing business as 3 Form - West Valley City
Authorized official Leizman, Jon
Entity Organization
Organization subpart 1 No
Enumeration date Jul 27th, 2021
Last updated Aug 24th, 2022 - about 2 years ago

1 Some organizations, which are providing health care services, may consist of units or departments that provide different types of health care services or have several separate physical locations, where health care service is provided. These units, departments or physical locations are not themselves legal entities. However, each of them is part of the organization, which is a legal entity. The organization may decide whether its subparts, if it has any, should have their own NPI numbers. In case a subpart conducts any HIPAA standard transactions by itself, without its parent's involvement, it must have its own NPI number.

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