Provider Demographics
NPI:1447474929
Name:ORTHOUTAH, LLC
Entity type:Organization
Organization Name:ORTHOUTAH, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MATTHEW
Authorized Official - Middle Name:FETZER
Authorized Official - Last Name:BITNER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:435-734-2151
Mailing Address - Street 1:990 MEDICAL DR
Mailing Address - Street 2:SUITE G4
Mailing Address - City:BRIGHAM CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84302-4713
Mailing Address - Country:US
Mailing Address - Phone:435-734-2151
Mailing Address - Fax:435-734-2192
Practice Address - Street 1:990 MEDICAL DR
Practice Address - Street 2:SUITE G4
Practice Address - City:BRIGHAM CITY
Practice Address - State:UT
Practice Address - Zip Code:84302-4713
Practice Address - Country:US
Practice Address - Phone:435-734-2151
Practice Address - Fax:435-723-3391
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-13
Last Update Date:2021-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT1447474929Medicaid
UT000060863Medicare PIN
UT6594510001Medicare NSC