Provider Demographics
NPI:1053692038
Name:MOUNTAIN WEST CARDIOVASCULAR ASSOCIATES, PC
Entity type:Organization
Organization Name:MOUNTAIN WEST CARDIOVASCULAR ASSOCIATES, PC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CREDENTIALING CO
Authorized Official - Prefix:MRS
Authorized Official - First Name:TERI
Authorized Official - Middle Name:J
Authorized Official - Last Name:WARDLE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:801-676-3723
Mailing Address - Street 1:1160 E 3900 S
Mailing Address - Street 2:SUITE 2000
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84124-1202
Mailing Address - Country:US
Mailing Address - Phone:801-266-3418
Mailing Address - Fax:801-288-4456
Practice Address - Street 1:74 KIMBALLS LN
Practice Address - Street 2:SUITE 260 A
Practice Address - City:DRAPER
Practice Address - State:UT
Practice Address - Zip Code:84020-5004
Practice Address - Country:US
Practice Address - Phone:801-571-6100
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-09-02
Last Update Date:2011-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Single Specialty