1972674232 NPI number — LAKEVIEW PROFESSIONAL BILLING LLC

Table of content: (NPI 1972674232)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1972674232 NPI number — LAKEVIEW PROFESSIONAL BILLING LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
LAKEVIEW PROFESSIONAL BILLING 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:
HOSPITAL CORPORATION OF UTAH
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:
1972674232
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 639
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BOUNTIFUL
Provider Business Mailing Address State Name:
UT
Provider Business Mailing Address Postal Code:
84011-0639
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
801-299-2145
Provider Business Mailing Address Fax Number:
801-299-7811

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
630 E MEDICAL DR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BOUNTIFUL
Provider Business Practice Location Address State Name:
UT
Provider Business Practice Location Address Postal Code:
84010
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
801-299-2165
Provider Business Practice Location Address Fax Number:
801-299-7811
Provider Enumeration Date:
11/10/2006

Additional Information

Authorized Official

Authorized Official Last Name:
PEREZ
Authorized Official First Name:
SHANAE
Authorized Official Middle Name:
D
Authorized Official Title or Position:
BILLING SUPERVISOR
Authorized Official Telephone Number:
801-299-2165

Provider Taxonomy Codes

  • Taxonomy code: 207R00000X , with the licence number:  1497971205 , registered in the state of UT ; information, associated with the NPI states the following Primary Taxonomy Switch: "X" .
  • Taxonomy code: 207R00000X , with the licence number: 1554671205 , registered in the state of UT ; information, associated with the NPI states the following Primary Taxonomy Switch: "X" .
  • Taxonomy code: 207R00000X , with the licence number: 1622661205 , registered in the state of UT ; information, associated with the NPI states the following Primary Taxonomy Switch: "X" .
  • Taxonomy code: 207R00000X , with the licence number: 1551991205 , registered in the state of UT ; information, associated with the NPI states the following Primary Taxonomy Switch: "X" .
  • Taxonomy code: 207RC0000X , with the licence number: 27742911205 , registered in the state of UT ; information, associated with the NPI states the following Primary Taxonomy Switch: "X" .
  • Taxonomy code: 207RC0000X , with the licence number: 1686031205 , registered in the state of UT ; information, associated with the NPI states the following Primary Taxonomy Switch: "X" .
  • Taxonomy code: 207RP1001X , with the licence number: 1674321205 , registered in the state of UT ; information, associated with the NPI states the following Primary Taxonomy Switch: "X" .

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

  • Identifier: 52856630402001 , issued by the state of ( UT ) . This identifiers is of the category "MEDICAID".
  • Identifier: 044424281001 , issued by the state of ( UT ) . This identifiers is of the category "MEDICAID".
  • Identifier: 528443301001 , issued by the state of ( UT ) . This identifiers is of the category "MEDICAID".
  • Identifier: 566476556001 , issued by the state of ( UT ) . This identifiers is of the category "MEDICAID".
  • Identifier: 528763507002 , issued by the state of ( UT ) . This identifiers is of the category "MEDICAID".




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