1639200215 NPI number — RYAN K ANDERSON D P M P C.

Table of content: (NPI 1639200215)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1639200215 NPI number — RYAN K ANDERSON D P M P C.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
RYAN K ANDERSON D P M 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:
FOOT & ANKLE SPECIALISTS OF UTAH
Provider Other Organization Name Type Code:
3
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:
1639200215
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
02/27/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 1249
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BOUNTIFUL
Provider Business Mailing Address State Name:
UT
Provider Business Mailing Address Postal Code:
84011-1249
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
801-296-2113
Provider Business Mailing Address Fax Number:
801-296-1715

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
596 W 750 S
Provider Second Line Business Practice Location Address:
SUITE 200
Provider Business Practice Location Address City Name:
BOUNTIFUL
Provider Business Practice Location Address State Name:
UT
Provider Business Practice Location Address Postal Code:
84010-7268
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
801-292-4425
Provider Business Practice Location Address Fax Number:
801-397-1938
Provider Enumeration Date:
03/08/2007

Additional Information

Authorized Official

Authorized Official Last Name:
ANDERSON
Authorized Official First Name:
RYAN
Authorized Official Middle Name:
K
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
801-292-4425

Provider Taxonomy Codes

  • Taxonomy code: 213ES0103X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 74619 . This is a "PEHP" identifier , issued by the state of ( UT ) . This identifiers is of the category "OTHER".
  • Identifier: 529471093001 , issued by the state of ( UT ) . This identifiers is of the category "MEDICAID".




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