Dr. Brian Liljenquist PLLC

Primary specialty

Multi-Specialty Clinic/CenterTaxonomy code 261QM1300X

License

8763069-1204 Issued in UT

Legal business name

DR. BRIAN LILJENQUIST PLLC

Doing business as

Elite Primary Care
Surgical Wound Care Associates

Practice address

1250 E 3900 S Ste 440
Salt Lake City, UT 84124

Phone

(801) 869-4100

Fax

(801) 869-4119

NPI assigned

Feb 21, 2017

Organization subpart

No

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

Authorized official

Name

Dr. Brian Liljenquist, DPM

Title

Managing Partner

Phone

(801) 869-4100

Specialties & licenses 6

Addresses

Other names 2

• Elite Primary Care Doing business as
• Surgical Wound Care Associates Doing business as

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Bret R Boyle, D.O.

  • Undersea and Hyperbaric Medicine (Preventive Medicine) Physician
  • Salt Lake City, UT
  • NPI 1598844839
  NPD (past)
• Linda S Cox, APRN

  • Family Nurse Practitioner
  • Salt Lake City, UT
  • NPI 1255353587
  NPD (past)

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

{
    "created_epoch": "1487635200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1529107200000",
    "number": "1174062376",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1250 E 3900 S STE 440",
            "city": "SALT LAKE CITY",
            "state": "UT",
            "postal_code": "841241349",
            "telephone_number": "801-869-4100",
            "fax_number": "801-869-4119"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1250 E 3900 S STE 440",
            "city": "SALT LAKE CITY",
            "state": "UT",
            "postal_code": "84124",
            "telephone_number": "801-869-4100",
            "fax_number": "801-869-4119"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "325 W Center St",
            "address_purpose": "LOCATION",
            "city": "Spanish Fork",
            "state": "UT",
            "postal_code": "846602060",
            "country_code": "US",
            "telephone_number": "801-999-0261",
            "fax_number": "844-436-6836",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "1250 E 3900 S Ste 440",
            "address_purpose": "LOCATION",
            "city": "Salt Lake City",
            "state": "UT",
            "postal_code": "841241349",
            "country_code": "US",
            "telephone_number": "801-999-0261",
            "fax_number": "844-436-6836",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "DR. BRIAN LILJENQUIST PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2017-02-21",
        "last_updated": "2018-06-16",
        "status": "A",
        "authorized_official_last_name": "LILJENQUIST",
        "authorized_official_first_name": "BRIAN",
        "authorized_official_title_or_position": "MANAGING PARTNER",
        "authorized_official_telephone_number": "801-869-4100",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DPM"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Family Medicine",
            "state": "UT",
            "license": "9140789-1205",
            "primary": false
        },
        {
            "code": "208600000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Surgery",
            "state": "UT",
            "license": "8763069-1204",
            "primary": false
        },
        {
            "code": "2086S0127X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Surgery, Trauma Surgery",
            "state": "UT",
            "license": "8763069-1204",
            "primary": false
        },
        {
            "code": "213ES0103X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Podiatrist, Foot & Ankle Surgery",
            "state": "UT",
            "license": "83699990501",
            "primary": false
        },
        {
            "code": "2251G0304X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Physical Therapist, Geriatrics",
            "state": "UT",
            "license": "292357-2401",
            "primary": false
        },
        {
            "code": "261QM1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Multi-Specialty",
            "state": "UT",
            "license": "8763069-1204",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Elite Primary Care",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Surgical Wound Care Associates",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Surgical Wound Care Associates",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• Multi-Specialty Clinic/Center in Salt Lake City, UT
• Providers in Salt Lake City, UT by specialty
• Multi-Specialty Clinic/Center in Utah

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 16, 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.