NPIMap

Organization Active NPI

Mountain Moments

  • Health Service Clinic/Center
  • Park City, UT
National Provider Identifier
1306466636
Registry record updated Apr 16, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Health Service Clinic/CenterTaxonomy code 261QH0100X
Legal business name
MOUNTAIN MOMENTS
Practice address
1154 Center Dr Ste D250
Park City, UT 84098-1258
Phone
(206) 795-4360
NPI assigned
Apr 16, 2020
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 16, 2020

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

Authorized official

Name
Carly BrooksNPI 1194067199
Title
Ceo/Founder
Phone
(206) 795-4360

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Health Service Clinic/Center 261QH0100X Primary

Addresses

Primary practice location

1154 Center Dr Ste D250
Park City, UT 84098-1258

Mailing address

PO Box 683745
Park City, UT 84068-3745

National Provider Directory

National Provider Directory

Locations

1154 Center Dr
Ste D250
Park City, UT 84098
Phone (206) 795-4360

Practitioners & affiliated clinicians

Practitioners 1

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

NPI Registry JSON

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

{
    "created_epoch": "1586995200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1586995200000",
    "number": "1306466636",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 683745",
            "city": "PARK CITY",
            "state": "UT",
            "postal_code": "840683745"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1154 CENTER DR STE D250",
            "city": "PARK CITY",
            "state": "UT",
            "postal_code": "840981258",
            "telephone_number": "206-795-4360"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MOUNTAIN MOMENTS",
        "organizational_subpart": "NO",
        "enumeration_date": "2020-04-16",
        "last_updated": "2020-04-16",
        "certification_date": "2020-04-16",
        "status": "A",
        "authorized_official_last_name": "BROOKS",
        "authorized_official_first_name": "CARLY",
        "authorized_official_title_or_position": "CEO/FOUNDER",
        "authorized_official_telephone_number": "206-795-4360"
    },
    "taxonomies": [
        {
            "code": "261QH0100X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Health Service",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Park City, UT

Sources for this page

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