1659384204 NPI number — DR. DALE A. WOODFIELD AND ASSOCIATES, LLC

Table of content: (NPI 1659384204)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1659384204 NPI number — DR. DALE A. WOODFIELD AND ASSOCIATES, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
DR. DALE A. WOODFIELD AND ASSOCIATES, 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:
1659384204
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/20/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
492 W 3975 N
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
PLEASANT VIEW
Provider Business Mailing Address State Name:
UT
Provider Business Mailing Address Postal Code:
84414-1400
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
801-689-3550
Provider Business Mailing Address Fax Number:
801-392-1291

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3651 WALL AVE
Provider Second Line Business Practice Location Address:
1226
Provider Business Practice Location Address City Name:
OGDEN
Provider Business Practice Location Address State Name:
UT
Provider Business Practice Location Address Postal Code:
84405-7110
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
801-621-0554
Provider Business Practice Location Address Fax Number:
801-392-1291
Provider Enumeration Date:
08/14/2006

Additional Information

Authorized Official

Authorized Official Last Name:
WOODFIELD
Authorized Official First Name:
DALE
Authorized Official Middle Name:
A
Authorized Official Title or Position:
MANAGING MEMBER
Authorized Official Telephone Number:
801-621-0554

Provider Taxonomy Codes

  • Taxonomy code: 152W00000X , with the licence number:  111847-9934 , 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: DD3972 . This is a "GROUP RAILROAD MEDICARE" identifier , issued by the state of ( UT ) . This identifiers is of the category "OTHER".




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