1184630154 NPI number — TROY REX CHILD MD

Table of content: DR. TINA MAI PHARM.D. (NPI 1902343049)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1184630154 NPI number — TROY REX CHILD MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
CHILD
Provider First Name:
TROY
Provider Middle Name:
REX
Provider Name Prefix Text:
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:
1184630154
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
05/15/2025
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3300 N TRIUMPH BLVD STE G50
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LEHI
Provider Business Mailing Address State Name:
UT
Provider Business Mailing Address Postal Code:
84043-6480
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:
4401 HARRISON BOULEVARD
Provider Second Line Business Practice Location Address:
MCKAY DEE HOSPITAL
Provider Business Practice Location Address City Name:
OGDEN
Provider Business Practice Location Address State Name:
UT
Provider Business Practice Location Address Postal Code:
84403
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
801-387-2800
Provider Business Practice Location Address Fax Number:
801-733-5618
Provider Enumeration Date:
07/31/2006

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:  97-343134-1205 , 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: 107008033101 . This is a "IHC" 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: PRA02408 . This is a "MOLINA" identifier , issued by the state of ( UT ) . This identifiers is of the category "OTHER".
  • Identifier: 10326 . This is a "HEALTHY U" identifier , issued by the state of ( UT ) . This identifiers is of the category "OTHER".
  • Identifier: 805668400 , issued by the state of ( ID ) . This identifiers is of the category "MEDICAID".
  • Identifier: 100501275 , issued by the state of ( NV ) . This identifiers is of the category "MEDICAID".
  • Identifier: 310746 . This is a "DESERET MUTUAL" identifier , issued by the state of ( UT ) . This identifiers is of the category "OTHER".
  • Identifier: 114801000 , issued by the state of ( WY ) . 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: 44544 . This is a "PEHP" identifier , issued by the state of ( UT ) . This identifiers is of the category "OTHER".
  • Identifier: 822157 , issued by the state of ( AZ ) . This identifiers is of the category "MEDICAID".
  • Identifier: 870545614CH3 . This is a "EDUCATORS MUTUAL" 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: 8597445 . This is a "WORKERS COMP FUND" identifier , issued by the state of ( UT ) . This identifiers is of the category "OTHER".




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