1467830281 NPI number — ONSITE CARE AT MPMC

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 1467830281 NPI number — ONSITE CARE AT MPMC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ONSITE CARE AT MPMC
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:
1467830281
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
01/30/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
560 S 300 E STE 275
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SALT LAKE CITY
Provider Business Mailing Address State Name:
UT
Provider Business Mailing Address Postal Code:
84111-3586
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
801-441-1002
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3000 N TRIUMPH BLVD
Provider Second Line Business Practice Location Address:
SUITE 320
Provider Business Practice Location Address City Name:
LEHI
Provider Business Practice Location Address State Name:
UT
Provider Business Practice Location Address Postal Code:
84043
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
801-753-4600
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
05/13/2015

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
LATSIS
Authorized Official First Name:
DARCE
Authorized Official Middle Name:
Authorized Official Title or Position:
OPERATIONS MANAGER
Authorized Official Telephone Number:
801-441-1002

Provider Taxonomy Codes

  • Taxonomy code: 261QP2300X , with the licence number:  70619161204 , 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)