1427240993 NPI number — FROGLEY HEALTH & WELLNESS CENTER

Table of content: (NPI 1427240993)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1427240993 NPI number — FROGLEY HEALTH & WELLNESS CENTER

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
FROGLEY HEALTH & WELLNESS CENTER
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:
INTEGRATED WELLNESS
Provider Other Organization Name Type Code:
5
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:
1427240993
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/20/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
10684 SOUTH RIVER PARKWAY
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SOUTH JORDAN
Provider Business Mailing Address State Name:
UT
Provider Business Mailing Address Postal Code:
84095
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
801-816-0332
Provider Business Mailing Address Fax Number:
801-816-0331

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
10684 SOUTH RIVER PARKWAY
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SOUTH JORDAN
Provider Business Practice Location Address State Name:
UT
Provider Business Practice Location Address Postal Code:
84095
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
801-816-0332
Provider Business Practice Location Address Fax Number:
801-816-0331
Provider Enumeration Date:
08/17/2007

Additional Information

Authorized Official

Authorized Official Last Name:
FROGLEY
Authorized Official First Name:
SCOTT
Authorized Official Middle Name:
H.
Authorized Official Title or Position:
OWNER/OPERATOR/DOCTOR
Authorized Official Telephone Number:
801-816-0332

Provider Taxonomy Codes

  • Taxonomy code: 111N00000X , with the licence number:  3275 , 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: 48592410602001 . This is a "BCBS TRADITIONAL" identifier , issued by the state of ( UT ) . This identifiers is of the category "OTHER".
  • Identifier: 48592410677001 . This is a "BCBS OTHERS" identifier , issued by the state of ( UT ) . This identifiers is of the category "OTHER".
  • Identifier: 214914 . This is a "ALTIUS" identifier , issued by the state of ( UT ) . This identifiers is of the category "OTHER".
  • Identifier: 485924106001 , issued by the state of ( UT ) . This identifiers is of the category "MEDICAID".
  • Identifier: 244741 . This is a "DMBA" identifier , issued by the state of ( UT ) . This identifiers is of the category "OTHER".
  • Identifier: 77248/38230 . This is a "PEHP" identifier , issued by the state of ( UT ) . This identifiers is of the category "OTHER".
  • Identifier: 87039551SFR . This is a "EMIA" identifier , issued by the state of ( UT ) . This identifiers is of the category "OTHER".




Copyright © 2007-2024 www.npivalidator.com