1245524651 NPI number — PEDIATRIC EMERGENCY SEDATION SERVICE

Table of content: DR. TERRY LYNN BOONE DDS,MS (NPI 1376691873)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1245524651 NPI number — PEDIATRIC EMERGENCY SEDATION SERVICE

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
PEDIATRIC EMERGENCY SEDATION SERVICE
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:
1245524651
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
09/06/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 413021
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SALT LAKE CITY
Provider Business Mailing Address State Name:
UT
Provider Business Mailing Address Postal Code:
84141-3021
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
801-213-3900
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
100 MARIO CAPECCHI DR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SALT LAKE CITY
Provider Business Practice Location Address State Name:
UT
Provider Business Practice Location Address Postal Code:
84113-1103
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
801-662-1234
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
06/02/2011

Additional Information

Authorized Official

Authorized Official Last Name:
MADONNA
Authorized Official First Name:
JANELL
Authorized Official Middle Name:
Authorized Official Title or Position:
CONTRACTING DIRECTOR
Authorized Official Telephone Number:
801-587-6464

Provider Taxonomy Codes

  • Taxonomy code: 2080P0204X , with the licence number:  3176341205 , 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