1326169632 NPI number — WEST VALLEY FAMILY AND PREVENTIVE MEDICINE

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1326169632 NPI number — WEST VALLEY FAMILY AND PREVENTIVE MEDICINE

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
WEST VALLEY FAMILY AND PREVENTIVE MEDICINE
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:
WEST VALLEY FAMILY AND PREVENTIVE MEDICINE
Provider Other Organization Name Type Code:
3
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:
1326169632
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/12/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3336 PIONEER PKWY
Provider Second Line Business Mailing Address:
#302
Provider Business Mailing Address City Name:
WEST VALLEY CITY
Provider Business Mailing Address State Name:
UT
Provider Business Mailing Address Postal Code:
84120-2000
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
801-964-8726
Provider Business Mailing Address Fax Number:
801-968-9836

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4100 SOUTH 1778 WEST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
WEST VALLEY CITY
Provider Business Practice Location Address State Name:
UT
Provider Business Practice Location Address Postal Code:
84119
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
801-964-8726
Provider Business Practice Location Address Fax Number:
801-968-9836
Provider Enumeration Date:
04/03/2007

Additional Information

Authorized Official

Authorized Official Last Name:
CAMPBELL
Authorized Official First Name:
JESSICA
Authorized Official Middle Name:
JANAE
Authorized Official Title or Position:
MANAGER
Authorized Official Telephone Number:
801-964-8726

Provider Taxonomy Codes

  • Taxonomy code: 207Q00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 480025031002 , issued by the state of ( UT ) . This identifiers is of the category "MEDICAID".




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