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

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 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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