Superior Healthcare of Spanish Fork

Primary specialty

Nurse PractitionerTaxonomy code 363L00000X

License

5129809-4405 Issued in UT

Legal business name

SUPERIOR HEALTHCARE OF SPANISH FORK

Practice address

750 N Main St
Spanish Fork, UT 84660-1147

Phone

(801) 798-2515

Fax

(801) 798-2510

NPI assigned

Jun 7, 2012

Organization subpart

No

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

Authorized official

Name

Brent Nephi Wall, D.C.

Title

President

Phone

(801) 798-2515

Specialties & licenses 1

Addresses

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

{
    "created_epoch": "1339027200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1339027200000",
    "number": "1255692075",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "750 N MAIN ST",
            "city": "SPANISH FORK",
            "state": "UT",
            "postal_code": "846601147",
            "telephone_number": "801-798-2515",
            "fax_number": "801-798-2510"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "750 N MAIN ST",
            "city": "SPANISH FORK",
            "state": "UT",
            "postal_code": "846601147",
            "telephone_number": "801-798-2515",
            "fax_number": "801-798-2510"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SUPERIOR HEALTHCARE OF SPANISH FORK",
        "organizational_subpart": "NO",
        "enumeration_date": "2012-06-07",
        "last_updated": "2012-06-07",
        "status": "A",
        "authorized_official_last_name": "WALL",
        "authorized_official_first_name": "BRENT",
        "authorized_official_middle_name": "NEPHI",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "801-798-2515",
        "authorized_official_credential": "D.C."
    },
    "taxonomies": [
        {
            "code": "363L00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Nurse Practitioner",
            "state": "UT",
            "license": "5129809-4405",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Scott Stroshine, D.O
• Summit Foot and Ankle Specialists
• Summit Spa & Float - Spanish Fork LLC
• Summit Spa & Float Inc.
• Sunset Living LLC
• Amy Michelle Sygnatowicz
• Roman Y Takasaki, M.D.
• Kelsie Taney, RN
• Sarah Ngocvi Tang, MD
• Laurie Mae Tashman, REGISTERED NURSE

• Nurse Practitioner in Spanish Fork, UT
• Providers in Spanish Fork, UT by specialty
• Nurse Practitioner in Utah

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 7, 2012; 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.