Provider Demographics
NPI:1043689953
Name:K & C ENTERPISES
Entity type:Organization
Organization Name:K & C ENTERPISES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:CLARK
Authorized Official - Middle Name:C
Authorized Official - Last Name:LARSEN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:801-554-0199
Mailing Address - Street 1:445 E MAPLEBERRY CT
Mailing Address - Street 2:
Mailing Address - City:DRAPER
Mailing Address - State:UT
Mailing Address - Zip Code:84020-6860
Mailing Address - Country:US
Mailing Address - Phone:801-554-0199
Mailing Address - Fax:
Practice Address - Street 1:445 E MAPLEBERRY CT
Practice Address - Street 2:
Practice Address - City:DRAPER
Practice Address - State:UT
Practice Address - Zip Code:84020-6860
Practice Address - Country:US
Practice Address - Phone:801-554-0199
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-09-21
Last Update Date:2015-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical