NPIMap

Organization Active NPI

Mountainstar Medical Group Timpanogos Specialty Care, LLC

  • Obstetrics & Gynecology Physician
  • Lehi, UT
National Provider Identifier
1184090870
Registry record updated Oct 28, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Obstetrics & Gynecology PhysicianTaxonomy code 207V00000X
Legal business name
MOUNTAINSTAR MEDICAL GROUP TIMPANOGOS SPECIALTY CARE, LLC
Practice address
1020 S 1100 W Ste B
Lehi, UT 84043-6041
Phone
(801) 653-2757
Fax
(801) 653-2747
NPI assigned
Aug 17, 2015
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 28, 2020

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

Authorized official

Name
William Tedrick Johnson
Title
Group VP/Ao
Phone
(615) 372-3375

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Obstetrics & Gynecology PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207V00000X Primary

Addresses

Primary practice location

1020 S 1100 W Ste B
Lehi, UT 84043-6041

Mailing address

2000 Health Park Dr
Brentwood, TN 37027-4525
Phone (615) 373-7600

National Provider Directory

National Provider Directory

Locations

3401 N Center St
Ste 150
Lehi, UT 84043
Phone (801) 653-2757

3340 N Center St
Lehi, UT 84043
Phone (801) 653-2757

NPI Registry JSON

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

{
    "created_epoch": "1439769600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1603843200000",
    "number": "1184090870",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2000 HEALTH PARK DR",
            "city": "BRENTWOOD",
            "state": "TN",
            "postal_code": "370274525",
            "telephone_number": "615-373-7600",
            "fax_number": "866-346-1426"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1020 S 1100 W STE B",
            "city": "LEHI",
            "state": "UT",
            "postal_code": "840436041",
            "telephone_number": "801-653-2757",
            "fax_number": "801-653-2747"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MOUNTAINSTAR MEDICAL GROUP TIMPANOGOS SPECIALTY CARE, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2015-08-17",
        "last_updated": "2020-10-28",
        "certification_date": "2020-10-28",
        "status": "A",
        "authorized_official_last_name": "JOHNSON",
        "authorized_official_first_name": "WILLIAM",
        "authorized_official_middle_name": "TEDRICK",
        "authorized_official_title_or_position": "GROUP VP/AO",
        "authorized_official_telephone_number": "615-372-3375"
    },
    "taxonomies": [
        {
            "code": "207V00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Obstetrics & Gynecology",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Lehi, UT

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 28, 2020; 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.