1780606731 NPI number — SAMUEL GREG HEYWOOD MD

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1780606731 NPI number — SAMUEL GREG HEYWOOD MD

Employer Identification Number (EIN):

Provider Organization Name:

Provider Last Name:

HEYWOOD

Provider First Name:

SAMUEL

Provider Middle Name:

GREG

Provider Name Prefix Text:

Provider Name Suffix Text:

Provider Credential Text:

MD

Provider Gender Code:

M

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:

1780606731

Entity Type Code:

Individual

Replacement NPI:

Last Update Date:

10/18/2024

NPI Deactivation Reason Code:

NPI Deactivation Date:

NPI Reactivation Date:

Provider First Line Business Mailing Address:

505 W 400 N STE C

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:

84057-1950

Provider Business Mailing Address Country Code:

US

Provider Business Mailing Address Telephone Number:

304-345-4525

Provider Business Mailing Address Fax Number:

304-345-4527

Provider First Line Business Practice Location Address:

505 W 400 N

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:

84057-1950

Provider Business Practice Location Address Country Code:

US

Provider Business Practice Location Address Telephone Number:

801-714-3422

Provider Business Practice Location Address Fax Number:

801-714-3424

Provider Enumeration Date:

07/25/2006

Authorized Official Last Name:

Authorized Official First Name:

Authorized Official Middle Name:

Authorized Official Title or Position:

Authorized Official Telephone Number:

• Taxonomy code: 207V00000X , with the licence number:  20012 , registered in the state of WV ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
• Taxonomy code: 207VX0000X , with the licence number: 11283381-1205 , registered in the state of UT ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

• Identifier: 550691297 . This is a "CIGNA" identifier , issued by the state of ( WV ) . This identifiers is of the category "OTHER".
• Identifier: 550691297 . This is a "SELECT NET" identifier , issued by the state of ( WV ) . This identifiers is of the category "OTHER".
• Identifier: 001717320 . This is a "BLUE CROSS" identifier , issued by the state of ( WV ) . This identifiers is of the category "OTHER".
• Identifier: 550691297 . This is a "CARELINK" identifier , issued by the state of ( WV ) . This identifiers is of the category "OTHER".
• Identifier: 550691297 . This is a "UNICARE" identifier , issued by the state of ( WV ) . This identifiers is of the category "OTHER".
• Identifier: 7672206 . This is a "AETNA" identifier , issued by the state of ( WV ) . This identifiers is of the category "OTHER".
• Identifier: 245048 . This is a "MAMSI UNITED HEALTH CARE" identifier , issued by the state of ( WV ) . This identifiers is of the category "OTHER".
• Identifier: 550691297 . This is a "TRICARE" identifier , issued by the state of ( WV ) . This identifiers is of the category "OTHER".
• Identifier: 1802068000 , issued by the state of ( WV ) . This identifiers is of the category "MEDICAID".
• Identifier: 550691297 . This is a "4 MOST" identifier , issued by the state of ( WV ) . This identifiers is of the category "OTHER".