Foothill Clinic, LLC
Organization Active NPI Family Medicine Physician · Salt Lake City, UT
NPI 1407947005 · NPPES record last updated Sep 15, 2008
Key facts
- NPI
- 1407947005
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Family Medicine Physician 207Q00000X
- Legal business name
- FOOTHILL CLINIC, LLC
- Practice address
- 2295 Foothill Dr
Salt Lake City, UT 84109-4000 - Phone
- (801) 486-3021
- Fax
- (801) 485-6339
- NPI assigned
- Sep 27, 2006
- Organization subpart
- No
Authorized official
- Name
- Dan C. Henry Jr., M.D.
- Title
- Authorized Official
- Phone
- (801) 486-3021
Other NPIs on the same Medicare enrollment 1
Other NPIs with the same Medicare PAC ID 1
Practitioners 57
-
Joseph Sterling Atkin, M.D.
-
Jose Azarcon Jr., D.O.
-
Ross A. Brunetti, M.D.
-
Katharine L Caldwell, M.D., M.P.H.
-
Shane G. Christensen, M.D.
-
Alexander Paul Clark, D.O.
-
Thomas K. Conner, MD
-
Shana K. Eborn, MD
-
Dan C. Henry Jr., MD
-
Jason Lee, DO
-
Wesley J. Lewis, MD
-
Tallya Llewelyn, DNP
-
Brian C McMullin, D.O.
-
Bryan L. Nelson, MD
-
Daniel Payne, MD
-
Alise Robison, PA
Laboratory certificates & supplier records
CLIA laboratory certificates
| CLIA number | Laboratory | Certificate | Expires |
|---|---|---|---|
| 46D0524018 | Foothill Family Clinic North | Compliance | Mar 22, 2028 |
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in UT
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20031122000151 | UT | Part B Supplier - Clinic/Group Practice | 9931003795 |
Receives reassigned benefits from 57 practitioners 1 other NPI on this enrollment Practice locations: Draper, UT; Salt Lake City, UT |
National Provider Directory
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Medicine Physician |
207Q00000X | Yes |
Addresses
Primary practice location
2295 Foothill Dr
Salt Lake City, UT 84109-4000
Mailing address
2295 Foothill Dr
Salt Lake City, UT 84109-4000
Phone (801) 486-3021
Other names
- Foothill Family Clinic
Other providers in Salt Lake City, UT
- Kori Foote
- Mark Charles Foote
- Jeremy David Footer
- Foothill Chiropractic, Inc
- Foothill Clinic, LLC
- Foothill Family Clinc Inc.
- Foothill Sports Medicine
- Laurie M Forbes
- Matthew Forbes
- Ty Forbes
All providers in Salt Lake City, UT · Family Medicine Physician in Utah
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Sep 15, 2008. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.