OrganizationPark City Internal Medicine - Pediatrics, LcClinic/CenterAmbulatory Health Care FacilitiesPractice Address1612 Ute Blvd, Ste 205, Park City, UT 84098-7500(435) 655-3309PECOS EnrollmentBased on the most recent information from CMS, provider Park City Internal Medicine - Pediatrics, Lc does not have current enrollment records in PECOS.Part BMedicare Part BNot EnrolledHHAHome Health AgencyNot EnrolledDMEDurable Medical EquipmentNot EnrolledPMDPower Mobility DeviceNot EnrolledCMS last updated its PECOS records today at 11:47 AM.Profile DetailsProvider ID1750569562Provider TypeOrganizationFull NamePark City Internal Medicine - Pediatrics, LcSubpartNoEnumeration Date2/4/2008Last Updated5/18/2011Contact InformationPractice LocationPractice Address1612 Ute Blvd, Ste 205, Park City, UT 84098-7500Phone(435) 655-3309Fax(435) 655-3392Mailing LocationMailing Address1612 Ute Blvd, Ste 205, Park City, UT 84098-7500Phone(435) 655-3309Fax(435) 655-3392Authorized OfficialNamePeacock, Penny (Owner)Phone(435) 655-3309Provider TaxonomiesCodeDescriptionLicenseCode261QH0100XPrimaryDescriptionClinic/CenterAmbulatory Health Care FacilitiesLicense5151398-1205Utah