1386691558 NPI number — DR. ANN JEFFERDS MD

Table of content: DR. ANN JEFFERDS MD (NPI 1386691558)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1386691558 NPI number — DR. ANN JEFFERDS MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
JEFFERDS
Provider First Name:
ANN
Provider Middle Name:
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
MD
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:
1386691558
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/21/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
324 TENTH AVE
Provider Second Line Business Mailing Address:
SUITE #160
Provider Business Mailing Address City Name:
SALT LAKE CITY
Provider Business Mailing Address State Name:
UT
Provider Business Mailing Address Postal Code:
84103-2853
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
801-408-5151
Provider Business Mailing Address Fax Number:
801-408-3598

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
UNIVERSITY OF UTAH MEDICAL CENTER 50 NORTH # 160
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:
84132-2853
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
801-581-2121
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
05/31/2006

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: 207RC0200X , with the licence number:  181614-1205 , registered in the state of UT ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207RP1001X , with the licence number: 181614-1205 , 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: 9200041 . This is a "UNITED HEALTH CARE #" identifier , issued by the state of ( UT ) . This identifiers is of the category "OTHER".
  • Identifier: 224997 . This is a "ALTIUS PROVIDER NUMBER" identifier , issued by the state of ( UT ) . This identifiers is of the category "OTHER".
  • Identifier: 29652 . This is a "PEHP PROVIDER #" identifier , issued by the state of ( UT ) . This identifiers is of the category "OTHER".
  • Identifier: 010133899 . This is a "TEAMSTERS #" identifier , issued by the state of ( UT ) . This identifiers is of the category "OTHER".
  • Identifier: 110182384 . This is a "RAILROAD EMPS INS ID" identifier , issued by the state of ( UT ) . This identifiers is of the category "OTHER".
  • Identifier: 870623071 . This is a "MOLINA PROVIDER #" identifier , issued by the state of ( UT ) . This identifiers is of the category "OTHER".




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