Metamorphosis Salt Lake City, Inc.

Primary specialty

Methadone ClinicTaxonomy code 261QM2800X

License

5863251-8913 Issued in UT

Legal business name

METAMORPHOSIS SALT LAKE CITY, INC.

Practice address

339 E 3900 S
Suite 101
Salt Lake City, UT 84107-1677

Phone

(801) 261-5790

NPI assigned

Nov 19, 2008

Organization subpart

No

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

Authorized official

Name

Jerry Costley

Title

Chief Operating Office

Phone

(801) 261-5790

Specialties & licenses 1

Addresses

Locations

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

{
    "created_epoch": "1227052800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1227052800000",
    "number": "1346495298",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "339 E 3900 S",
            "address_2": "SUITE 101",
            "city": "SALT LAKE CITY",
            "state": "UT",
            "postal_code": "841071677",
            "telephone_number": "801-261-5790"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "339 E 3900 S",
            "address_2": "SUITE 101",
            "city": "SALT LAKE CITY",
            "state": "UT",
            "postal_code": "841071677",
            "telephone_number": "801-261-5790"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "METAMORPHOSIS SALT LAKE CITY, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-11-19",
        "last_updated": "2008-11-19",
        "status": "A",
        "authorized_official_last_name": "COSTLEY",
        "authorized_official_first_name": "JERRY",
        "authorized_official_title_or_position": "CHIEF OPERATING OFFICE",
        "authorized_official_telephone_number": "801-261-5790"
    },
    "taxonomies": [
        {
            "code": "261QM2800X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Methadone",
            "state": "UT",
            "license": "5863251-8913",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Chelsey Erin Mestas
• Jennifer L Meszaros, PA-C
• Metasmiles, Inc.
• Joshua J. Metcalf, MD
• Molly Emma Metcalf
• Thomas J Metcalf, MD
• Athena Metos, MAMFT

• Methadone Clinic in Salt Lake City, UT
• Providers in Salt Lake City, UT by specialty
• Methadone Clinic in Utah

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 19, 2008; 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.