1760791826 NPI number — MR. CHRIS WOODS

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1760791826 NPI number — MR. CHRIS WOODS

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
WOODS
Provider First Name:
CHRIS
Provider Middle Name:
Provider Name Prefix Text:
MR.
Provider Name Suffix Text:
Provider Credential Text:
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:
1760791826
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
10/06/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 133
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MARYSVALE
Provider Business Mailing Address State Name:
UT
Provider Business Mailing Address Postal Code:
84750-0133
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
435-201-9215
Provider Business Mailing Address Fax Number:
435-527-8883

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
8510 S TEN MILE RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MARYSVALE
Provider Business Practice Location Address State Name:
UT
Provider Business Practice Location Address Postal Code:
84750
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
435-201-9215
Provider Business Practice Location Address Fax Number:
435-527-8883
Provider Enumeration Date:
10/06/2010

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: 101Y00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 253J00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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