1134403629 NPI number — ALTA MOUNTAIN HEALTH & WELLNESS

Table of content: (NPI 1134403629)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1134403629 NPI number — ALTA MOUNTAIN HEALTH & WELLNESS

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ALTA MOUNTAIN HEALTH & WELLNESS
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:
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:
1134403629
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/04/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
4692 RAINBOW DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MURRAY
Provider Business Mailing Address State Name:
UT
Provider Business Mailing Address Postal Code:
84107-3810
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
9035 S 1300 E
Provider Second Line Business Practice Location Address:
SUITE 1B
Provider Business Practice Location Address City Name:
SANDY
Provider Business Practice Location Address State Name:
UT
Provider Business Practice Location Address Postal Code:
84094-3132
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
801-569-8787
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
10/04/2011

Additional Information

Authorized Official

Authorized Official Last Name:
ELDREDGE
Authorized Official First Name:
NATHAN
Authorized Official Middle Name:
TYLER
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
801-569-8787

Provider Taxonomy Codes

  • Taxonomy code: 111N00000X , with the licence number:  5501297-1202 , 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)





Copyright © 2007-2025 www.npivalidator.com