1083721765 NPI number — DR. JAYAPRAKASH MOODALAGIRIAPPA MD

Table of content: DR. JAYAPRAKASH MOODALAGIRIAPPA MD (NPI 1083721765)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1083721765 NPI number — DR. JAYAPRAKASH MOODALAGIRIAPPA MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MOODALAGIRIAPPA
Provider First Name:
JAYAPRAKASH
Provider Middle Name:
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:
1083721765
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
10/15/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3340 NORTH CENTER ST
Provider Second Line Business Mailing Address:
#800
Provider Business Mailing Address City Name:
LEHI
Provider Business Mailing Address State Name:
UT
Provider Business Mailing Address Postal Code:
84043-7406
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
801-990-1911
Provider Business Mailing Address Fax Number:
801-990-1912

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
5121 S COTTONWOOD STREET
Provider Second Line Business Practice Location Address:
INTERMOUNTAIN MEDICAL CENTER
Provider Business Practice Location Address City Name:
MURRAY
Provider Business Practice Location Address State Name:
UT
Provider Business Practice Location Address Postal Code:
84157
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
801-507-5248
Provider Business Practice Location Address Fax Number:
801-432-2668
Provider Enumeration Date:
08/25/2006

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: 207L00000X , with the licence number:  74-156806-1205 , 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: 37806 . This is a "PEHP" identifier , issued by the state of ( UT ) . This identifiers is of the category "OTHER".
  • Identifier: 35683 . This is a "DESERET MUTUAL" identifier , issued by the state of ( UT ) . This identifiers is of the category "OTHER".
  • Identifier: 002999200 , issued by the state of ( ID ) . This identifiers is of the category "MEDICAID".
  • Identifier: 107005021101 . This is a "IHC" identifier , issued by the state of ( UT ) . This identifiers is of the category "OTHER".
  • Identifier: 8597445 . This is a "WORKERS COMP FUND" identifier , issued by the state of ( UT ) . This identifiers is of the category "OTHER".
  • Identifier: QM0000075886 . This is a "ALTIUS" identifier , issued by the state of ( UT ) . This identifiers is of the category "OTHER".
  • Identifier: 002085089 , issued by the state of ( NV ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1502954 . This is a "UMWA" identifier , issued by the state of ( UT ) . This identifiers is of the category "OTHER".
  • Identifier: 857394 , issued by the state of ( AZ ) . This identifiers is of the category "MEDICAID".
  • Identifier: PRA02897 . This is a "MOLINA" identifier , issued by the state of ( UT ) . This identifiers is of the category "OTHER".
  • Identifier: 2090168 . This is a "UNITED HEALTHCARE" identifier , issued by the state of ( UT ) . This identifiers is of the category "OTHER".
  • Identifier: 107961100 , issued by the state of ( WY ) . This identifiers is of the category "MEDICAID".
  • Identifier: 53245 . This is a "HEALTHY U" identifier , issued by the state of ( UT ) . This identifiers is of the category "OTHER".
  • Identifier: 870545614JA1 . This is a "EDUCATORS MUTUAL" identifier , issued by the state of ( UT ) . This identifiers is of the category "OTHER".




Copyright © 2007-2024 www.npivalidator.com