1336285782 NPI number — SOUTHWESTERN OBSTETRICS & GYNECOLOGY P C

Table of content: JASON MICHAEL KURLAND MD (NPI 1194940692)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1336285782 NPI number — SOUTHWESTERN OBSTETRICS & GYNECOLOGY P C

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
SOUTHWESTERN OBSTETRICS & GYNECOLOGY P C
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:
1336285782
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
06/07/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
39 PROFESSIONAL WAY
Provider Second Line Business Mailing Address:
#3
Provider Business Mailing Address City Name:
PAYSON
Provider Business Mailing Address State Name:
UT
Provider Business Mailing Address Postal Code:
84651-1675
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
801-465-9263
Provider Business Mailing Address Fax Number:
801-465-1669

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
39 PROFESSIONAL WAY
Provider Second Line Business Practice Location Address:
#3
Provider Business Practice Location Address City Name:
PAYSON
Provider Business Practice Location Address State Name:
UT
Provider Business Practice Location Address Postal Code:
84651-1675
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
801-465-9263
Provider Business Practice Location Address Fax Number:
801-465-1669
Provider Enumeration Date:
01/30/2007

Additional Information

Authorized Official

Authorized Official Last Name:
DEWEY
Authorized Official First Name:
STEVEN
Authorized Official Middle Name:
J
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
801-465-9263

Provider Taxonomy Codes

  • Taxonomy code: 207V00000X , with the licence number:  177851-1205 , 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: 528887176001 , issued by the state of ( UT ) . This identifiers is of the category "MEDICAID".




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