1750333092 NPI number — DR. MICHAEL HAWKES METCALF M.D.

Table of content: DR. MICHAEL HAWKES METCALF M.D. (NPI 1750333092)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1750333092 NPI number — DR. MICHAEL HAWKES METCALF M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
METCALF
Provider First Name:
MICHAEL
Provider Middle Name:
HAWKES
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
M.D.
Provider Gender Code:
M

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:
1750333092
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
10/11/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1820 SIDEWINDER DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
PARK CITY
Provider Business Mailing Address State Name:
UT
Provider Business Mailing Address Postal Code:
84060-7492
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
435-655-6600
Provider Business Mailing Address Fax Number:
435-655-2388

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1820 SIDEWINDER DR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
PARK CITY
Provider Business Practice Location Address State Name:
UT
Provider Business Practice Location Address Postal Code:
84060-7492
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
435-655-6600
Provider Business Practice Location Address Fax Number:
435-655-2388
Provider Enumeration Date:
05/16/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207XX0005X , with the licence number:  4956934-1205 , 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: TPRA09041 . This is a "MOLINA ADVANTAGE" identifier , issued by the state of ( UT ) . This identifiers is of the category "OTHER".
  • Identifier: 841433992MM2 . This is a "EDUCATORS MUTUAL" identifier , issued by the state of ( UT ) . This identifiers is of the category "OTHER".
  • Identifier: 49569348901001 . This is a "SELECT HEALTH PLANS" identifier , issued by the state of ( UT ) . This identifiers is of the category "OTHER".
  • Identifier: 68380 . This is a "PUBLIC EMPLOYEES HEALTH" identifier , issued by the state of ( UT ) . This identifiers is of the category "OTHER".
  • Identifier: 09-00368 . This is a "UNITED HEALTH CARE" identifier , issued by the state of ( UT ) . This identifiers is of the category "OTHER".




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