1083685101 NPI number — DR. JAMES G THEURER MD

Table of content: DR. JAMES G THEURER MD (NPI 1083685101)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1083685101 NPI number — DR. JAMES G THEURER MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
THEURER
Provider First Name:
JAMES
Provider Middle Name:
G
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
MD
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:
1083685101
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
09/16/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
120 S 1025 E
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LINDON
Provider Business Mailing Address State Name:
UT
Provider Business Mailing Address Postal Code:
84042-2134
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
801-362-3151
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1735 N STATE ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
PROVO
Provider Business Practice Location Address State Name:
UT
Provider Business Practice Location Address Postal Code:
84604-1010
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
801-374-1818
Provider Business Practice Location Address Fax Number:
801-379-2959
Provider Enumeration Date:
01/27/2006

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: 207W00000X , with the licence number:  983624541205 , 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: 180041850 . This is a "RAILROAD MEDICARE" identifier , issued by the state of ( UT ) . This identifiers is of the category "OTHER".
  • Identifier: 5557665 . This is a "AETNA" identifier , issued by the state of ( UT ) . This identifiers is of the category "OTHER".
  • Identifier: 8064710002 . This is a "CIGNA" identifier , issued by the state of ( UT ) . This identifiers is of the category "OTHER".
  • Identifier: 87028357684604A001 . This is a "PGBA" identifier , issued by the state of ( UT ) . This identifiers is of the category "OTHER".
  • Identifier: 0800084 . This is a "UNITED HEALTHCARE" identifier , issued by the state of ( UT ) . This identifiers is of the category "OTHER".
  • Identifier: 87028357684604A001 . This is a "TRICARE" identifier , issued by the state of ( UT ) . This identifiers is of the category "OTHER".
  • Identifier: 870283576TH1 . This is a "EMIA" identifier , issued by the state of ( UT ) . This identifiers is of the category "OTHER".
  • Identifier: 345610 . This is a "DMBA" identifier , issued by the state of ( UT ) . This identifiers is of the category "OTHER".
  • Identifier: 1182764 . This is a "AFFORDABLE" identifier , issued by the state of ( UT ) . This identifiers is of the category "OTHER".
  • Identifier: 107008469102 . This is a "SELECT HEALTH" identifier , issued by the state of ( UT ) . This identifiers is of the category "OTHER".




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