1518266501 NPI number — ASPEN CLINICAL RESEARCH, LLC

Table of content: (NPI 1518266501)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1518266501 NPI number — ASPEN CLINICAL RESEARCH, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ASPEN CLINICAL RESEARCH, 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:
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:
1518266501
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
01/09/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1215 S 1680 W
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
OREM
Provider Business Mailing Address State Name:
UT
Provider Business Mailing Address Postal Code:
84058-4939
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
801-356-5555
Provider Business Mailing Address Fax Number:
801-224-6010

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1215 S 1680 W
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
OREM
Provider Business Practice Location Address State Name:
UT
Provider Business Practice Location Address Postal Code:
84058-4939
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
801-356-5555
Provider Business Practice Location Address Fax Number:
801-224-6010
Provider Enumeration Date:
03/16/2011

Additional Information

Authorized Official

Authorized Official Last Name:
DAWE
Authorized Official First Name:
IAN
Authorized Official Middle Name:
M.
Authorized Official Title or Position:
EXEC. V.P. BUSINESS DEVELOPMENT
Authorized Official Telephone Number:
801-356-5555

Provider Taxonomy Codes

  • Taxonomy code: 261QR1100X , with the licence number:  6777624-0160 , 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: 1912008590 . This is a "MICHAEL W. HARRIS, DO" identifier . This identifiers is of the category "OTHER".




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