Mobile Vivitrol, LLC

Primary specialty

Addiction Medicine (Family Medicine) PhysicianTaxonomy code 207QA0401X

Legal business name

MOBILE VIVITROL, LLC

Practice address

13032 Snow Crest CR
Draper, UT 84020

Phone

(801) 898-7778

NPI assigned

Feb 19, 2020

Last updated

Mar 12, 2021By the provider in NPPES

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Mark G. Richards

Title

Owner

Phone

(801) 898-7778

Specialties & licenses 1

Addresses

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Corey James Markisich, LSAC

  • Addiction (Substance Use Disorder) Counselor
  • Midvale, UT
  • NPI 1033438288
  NPD

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1582070400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1615507200000",
    "number": "1033742994",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 639",
            "city": "DRAPER",
            "state": "UT",
            "postal_code": "84020",
            "telephone_number": "801-558-6564"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "13032 SNOW CREST CR",
            "city": "DRAPER",
            "state": "UT",
            "postal_code": "84020",
            "telephone_number": "801-898-7778"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MOBILE VIVITROL, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2020-02-19",
        "last_updated": "2021-03-12",
        "certification_date": "2021-03-12",
        "status": "A",
        "authorized_official_last_name": "RICHARDS",
        "authorized_official_first_name": "MARK",
        "authorized_official_middle_name": "G.",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "801-898-7778"
    },
    "taxonomies": [
        {
            "code": "207QA0401X",
            "taxonomy_group": "",
            "desc": "Family Medicine, Addiction Medicine",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Kecia Mills
• Melissa Mills
• Sheila R Mioni, APRN
• Rebekkah Miranda, AG-ACNP
• Erica Steed Mitchell, PT, DPT
• Mockingbird Wellness
• Brookelyn Moeller
• Ryan C Moffat, DDS
• Chad Kenneth Molen, D.D.S.
• Alo Moli

• Addiction Medicine (Family Medicine) Physician in Draper, UT
• Providers in Draper, UT by specialty
• Addiction Medicine (Family Medicine) Physician in Utah

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 12, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.