NPIMap

Organization Active NPI

MTC Medical, LLC

  • Prison Health Clinic/Center
  • Centerville, UT
National Provider Identifier
1720759236
Registry record updated Sep 23, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Prison Health Clinic/CenterTaxonomy code 261QP2400X
Legal business name
MTC MEDICAL, LLC
Practice address
500 N Market Place Dr Ste 100
Centerville, UT 84014-1711
Phone
(801) 693-2918
NPI assigned
Sep 23, 2021
Last updated
Sep 23, 2021By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Sep 23, 2021

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

Authorized official

Name
Gabe Utley
Title
Finance Director
Phone
(801) 693-2918

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Multi-Specialty Clinic/Center 261QM1300X NU
Prison Health Clinic/Center 261QP2400X NU Primary

Addresses

Primary practice location

500 N Market Place Dr Ste 100
Centerville, UT 84014-1711

Mailing address

500 N Market Place Dr Ste 100
Centerville, UT 84014-1711
Phone (801) 693-2918

National Provider Directory

National Provider Directory

Locations

500 N Market Place Dr
Ste 100
Centerville, UT 84014
Phone (801) 693-2918

NPI Registry JSON

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

{
    "created_epoch": "1632355200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1632355200000",
    "number": "1720759236",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "500 N MARKET PLACE DR STE 100",
            "city": "CENTERVILLE",
            "state": "UT",
            "postal_code": "840141711",
            "telephone_number": "801-693-2918"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "500 N MARKET PLACE DR STE 100",
            "city": "CENTERVILLE",
            "state": "UT",
            "postal_code": "840141711",
            "telephone_number": "801-693-2918"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MTC MEDICAL, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2021-09-23",
        "last_updated": "2021-09-23",
        "certification_date": "2021-09-23",
        "status": "A",
        "authorized_official_last_name": "UTLEY",
        "authorized_official_first_name": "GABE",
        "authorized_official_title_or_position": "FINANCE DIRECTOR",
        "authorized_official_telephone_number": "801-693-2918"
    },
    "taxonomies": [
        {
            "code": "261QM1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Multi-Specialty",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "261QP2400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Prison Health",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Centerville, UT

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 23, 2021; 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.