1316972508 NPI number — HYPERBARIC MEDICINE PHYSICIANS LLC

Table of content: (NPI 1316972508)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1316972508 NPI number — HYPERBARIC MEDICINE PHYSICIANS LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
HYPERBARIC MEDICINE PHYSICIANS LLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1316972508
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/19/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
540 ARAPEEN DR STE 110
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SALT LAKE CITY
Provider Business Mailing Address State Name:
UT
Provider Business Mailing Address Postal Code:
84108-1258
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
801-582-4268
Provider Business Mailing Address Fax Number:
801-582-4269

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
540 ARAPEEN DR STE 110
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SALT LAKE CITY
Provider Business Practice Location Address State Name:
UT
Provider Business Practice Location Address Postal Code:
84108-1258
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
801-582-4268
Provider Business Practice Location Address Fax Number:
801-582-4269
Provider Enumeration Date:
07/12/2006

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
DEJOHN
Authorized Official First Name:
TERRI
Authorized Official Middle Name:
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
801-582-4268

Provider Taxonomy Codes

  • Taxonomy code: 207P00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207PE0005X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)