1417957291 NPI number — EDWARD H BUDGE PT

Table of content: EDWARD H BUDGE PT (NPI 1417957291)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1417957291 NPI number — EDWARD H BUDGE PT

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
BUDGE
Provider First Name:
EDWARD
Provider Middle Name:
H
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
PT
Provider Gender Code:
M

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:
1417957291
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
04/18/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
77 S 400 W
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SPANISH FORK
Provider Business Mailing Address State Name:
UT
Provider Business Mailing Address Postal Code:
84660-2053
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
801-798-1626
Provider Business Mailing Address Fax Number:
801-798-1236

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
77 S 400 W
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SPANISH FORK
Provider Business Practice Location Address State Name:
UT
Provider Business Practice Location Address Postal Code:
84660-2053
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
801-798-1626
Provider Business Practice Location Address Fax Number:
801-798-1236
Provider Enumeration Date:
07/22/2005

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 225100000X , with the licence number:  1212002401 , registered in the state of UT ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 64-00134 . This is a "UNITED HEALTHCARE ID#" identifier . This identifiers is of the category "OTHER".
  • Identifier: D1788/870578539003 , issued by the state of ( UT ) . This identifiers is of the category "MEDICAID".
  • Identifier: QM0000076331 . This is a "ALTIUS PROVIDER ID" identifier , issued by the state of ( UT ) . This identifiers is of the category "OTHER".
  • Identifier: 305418 . This is a "DMBA PROVIDER ID" identifier , issued by the state of ( UT ) . This identifiers is of the category "OTHER".
  • Identifier: 47728 . This is a "PEHP" identifier , issued by the state of ( UT ) . This identifiers is of the category "OTHER".
  • Identifier: 870578539BU1 . This is a "EDUCATORS MUTUAL PIN" identifier , issued by the state of ( UT ) . This identifiers is of the category "OTHER".




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