1326482712 NPI number — CLASSIC AIR CARE LLC

Table of content: DR. WILLIAM LEE HEREFORD M.D. (NPI 1336150226)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1326482712 NPI number — CLASSIC AIR CARE LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CLASSIC AIR CARE LLC
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:
6
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:
1326482712
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/02/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
5373 S GREEN ST STE 500
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:
84123-4680
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
801-295-5700
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2399 OXFORD WAY
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
STEAMBOAT SPRINGS
Provider Business Practice Location Address State Name:
CO
Provider Business Practice Location Address Postal Code:
80487-4991
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
801-295-5700
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
04/29/2013

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
GARAY-CARSON
Authorized Official First Name:
MIGUEL
Authorized Official Middle Name:
Authorized Official Title or Position:
REVENUE CYCLE MANAGER
Authorized Official Telephone Number:
385-297-3381

Provider Taxonomy Codes

  • Taxonomy code: 3416A0800X , with the licence number:  3003L , 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)