NPIMap

Organization Active NPI

Medically Directed Care Clinic Salt Lake LLC

Doing business as MDC Clinic

  • Clinic/Center
  • Salt Lake City, UT
National Provider Identifier
1548969306
Registry record updated Mar 1, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinic/CenterTaxonomy code 261Q00000X
Legal business name
MEDICALLY DIRECTED CARE CLINIC SALT LAKE LLC
Doing business as
MDC Clinic
Practice address
4465 S 900 E Ste 2754
Salt Lake City, UT 84124-2469
Phone
(435) 300-0472
NPI assigned
Mar 1, 2023
Last updated
Mar 1, 2023By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 1, 2023

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

Authorized official

Name
Aj Yergensen
Title
Admin
Phone
(435) 986-9369

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Clinic/Center 261Q00000X NU Primary

Addresses

Primary practice location

4465 S 900 E Ste 2754
Salt Lake City, UT 84124-2469

Mailing address

4465 S 900 E Ste 2754
Salt Lake City, UT 84124-2469

Other names 1

  • MDC CLINIC Doing business as

National Provider Directory

National Provider Directory

Locations

4465 S 900 E
Ste 2754
Salt Lake City, UT 84124
Phone (435) 300-0472

NPI Registry JSON

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

{
    "created_epoch": "1677628800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1677628800000",
    "number": "1548969306",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4465 S 900 E STE 2754",
            "city": "SALT LAKE CITY",
            "state": "UT",
            "postal_code": "841242469"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4465 S 900 E STE 2754",
            "city": "SALT LAKE CITY",
            "state": "UT",
            "postal_code": "841242469",
            "telephone_number": "435-300-0472"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MEDICALLY DIRECTED CARE CLINIC SALT LAKE LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2023-03-01",
        "last_updated": "2023-03-01",
        "certification_date": "2023-03-01",
        "status": "A",
        "authorized_official_last_name": "YERGENSEN",
        "authorized_official_first_name": "AJ",
        "authorized_official_title_or_position": "ADMIN",
        "authorized_official_telephone_number": "435-986-9369"
    },
    "taxonomies": [
        {
            "code": "261Q00000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "MDC CLINIC",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Salt Lake City, UT

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 1, 2023; 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.