Bluerock Medical LLC

Primary specialty

SpecialistTaxonomy code 174400000X

Legal business name

BLUEROCK MEDICAL LLC

Practice address

3152 N University Ave
Suite 130
Provo, UT 84604-4745

Phone

(801) 437-4895

Fax

(801) 229-1003

NPI assigned

Jul 9, 2013

Organization subpart

No

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

Authorized official

Name

Martha Hodges

Title

Billing Manager

Phone

(801) 437-4895

Specialties & licenses 1

Addresses

Locations

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

{
    "created_epoch": "1373328000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1373328000000",
    "number": "1629419452",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3152 N UNIVERSITY AVE",
            "address_2": "SUITE 130",
            "city": "PROVO",
            "state": "UT",
            "postal_code": "846044745",
            "telephone_number": "801-437-4895",
            "fax_number": "801-229-1003"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3152 N UNIVERSITY AVE",
            "address_2": "SUITE 130",
            "city": "PROVO",
            "state": "UT",
            "postal_code": "846044745",
            "telephone_number": "801-437-4895",
            "fax_number": "801-229-1003"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BLUEROCK MEDICAL LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2013-07-09",
        "last_updated": "2013-07-09",
        "status": "A",
        "authorized_official_last_name": "HODGES",
        "authorized_official_first_name": "MARTHA",
        "authorized_official_title_or_position": "BILLING MANAGER",
        "authorized_official_telephone_number": "801-437-4895"
    },
    "taxonomies": [
        {
            "code": "174400000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Specialist",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Kaycee Bodell

• Specialist in Provo, UT
• Providers in Provo, UT by specialty
• Specialist in Utah

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 9, 2013; 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.