NPIMap

Organization Active NPI

Ageless Womens Health Ut LLC

Doing business as Ageless Women's Health

  • Family Medicine Physician
  • Marriott Slaterville, UT
National Provider Identifier
1053017004
Registry record updated Mar 8, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
Legal business name
AGELESS WOMENS HEALTH UT LLC
Doing business as
Ageless Women's Health
Practice address
1920 W 250 N Ste 2
Marriott Slaterville, UT 84404-9234
Phone
(602) 582-1706
NPI assigned
Feb 1, 2023
Last updated
Mar 8, 2024By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 8, 2024

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

Authorized official

Name
Teah Smith
Title
Credentialing Manager
Phone
(901) 205-3999

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207Q00000X Primary

Addresses

Primary practice location

1920 W 250 N Ste 2
Marriott Slaterville, UT 84404-9234

Mailing address

1920 W 250 N Ste 2
Marriott Slaterville, UT 84404-9234
Phone (602) 582-1706

Other practice location 1

1680 W Reunion Ave Ste 5A
South Jordan, UT 84095-4620
Phone (385) 289-2088

Other names 1

  • Ageless Women's Health Doing business as

National Provider Directory

National Provider Directory

Locations

1920 W 250 N
Ste 2
Ogden, UT 84404
Phone (385) 289-2088

Practitioners & affiliated clinicians

Practitioners 5

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.

NPI Registry JSON

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

{
    "created_epoch": "1675209600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1709856000000",
    "number": "1053017004",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1920 W 250 N STE 2",
            "city": "MARRIOTT SLATERVILLE",
            "state": "UT",
            "postal_code": "844049234",
            "telephone_number": "602-582-1706"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1920 W 250 N STE 2",
            "city": "MARRIOTT SLATERVILLE",
            "state": "UT",
            "postal_code": "844049234",
            "telephone_number": "602-582-1706"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1680 W Reunion Ave Ste 5A",
            "address_purpose": "LOCATION",
            "city": "South Jordan",
            "state": "UT",
            "postal_code": "840954620",
            "country_code": "US",
            "telephone_number": "385-289-2088",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "AGELESS WOMENS HEALTH UT LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2023-02-01",
        "last_updated": "2024-03-08",
        "certification_date": "2024-03-08",
        "status": "A",
        "authorized_official_last_name": "SMITH",
        "authorized_official_first_name": "TEAH",
        "authorized_official_title_or_position": "CREDENTIALING MANAGER",
        "authorized_official_telephone_number": "901-205-3999"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Family Medicine",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Ageless Women's Health",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Ageless Women's Health",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Marriott Slaterville, UT

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 8, 2024; 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.