Guardian Family Medicine

Primary specialty

Primary Care Clinic/CenterTaxonomy code 261QP2300X

Legal business name

GUARDIAN FAMILY MEDICINE

Practice address

4612 N Independence Way
Eagle Mountain, UT 84005-6082

Phone

(801) 404-9662

NPI assigned

Aug 27, 2018

Last updated

Aug 27, 2018By 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

Mr. Shad Tillotson, NP

Title

Ceo/Owner

Phone

(801) 404-9662

Specialties & licenses 1

Addresses

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

{
    "created_epoch": "1535328000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1535328000000",
    "number": "1164903233",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4612 N INDEPENDENCE WAY",
            "city": "EAGLE MOUNTAIN",
            "state": "UT",
            "postal_code": "840056082",
            "telephone_number": "801-404-9662"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4612 N INDEPENDENCE WAY",
            "city": "EAGLE MOUNTAIN",
            "state": "UT",
            "postal_code": "840056082",
            "telephone_number": "801-404-9662"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GUARDIAN FAMILY MEDICINE",
        "organizational_subpart": "NO",
        "enumeration_date": "2018-08-27",
        "last_updated": "2018-08-27",
        "status": "A",
        "authorized_official_last_name": "TILLOTSON",
        "authorized_official_first_name": "SHAD",
        "authorized_official_title_or_position": "CEO/OWNER",
        "authorized_official_telephone_number": "801-404-9662",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "NP"
    },
    "taxonomies": [
        {
            "code": "261QP2300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Primary Care",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Darren James Gillespie, CSW
• Lindsay Marie Gneiting, PTA
• Marilee Goljahmofrad, LMT
• Sadie Goodrich
• Carol J Gross, BCBA, LCSW
• Braden Gurney, FNP-BC
• Evan Michael Gwilliam, DC
• Derek Willis Hagey, LMFT
• Hansen Home Speech, LLC
• Cera Marie Hansen, FNP-C

• Primary Care Clinic/Center in Eagle Mountain, UT
• Providers in Eagle Mountain, UT by specialty
• Primary Care Clinic/Center in Utah

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 27, 2018; 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.