1376063404 NPI number — MRS. TIFFANI HORNE BS RRT

Table of content: NICHOLAS SOONG-RAE CHO (NPI 1386384923)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1376063404 NPI number — MRS. TIFFANI HORNE BS RRT

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
HORNE
Provider First Name:
TIFFANI
Provider Middle Name:
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
BS RRT
Provider Gender Code:
F

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:
1376063404
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
06/20/2017
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
4531 S 2025 W
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ROY
Provider Business Mailing Address State Name:
UT
Provider Business Mailing Address Postal Code:
84067-3307
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
801-814-2127
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4885 S 900 E STE 107
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:
84117-3905
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
801-266-0399
Provider Business Practice Location Address Fax Number:
801-266-0421
Provider Enumeration Date:
06/20/2017

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: 227900000X , with the licence number:  4861666-5701 , 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)