1790739324 NPI number — DR. RUSSELL VAL HARWARD SR. DC

Table of content: (NPI 1457460735)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1790739324 NPI number — DR. RUSSELL VAL HARWARD SR. DC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
HARWARD
Provider First Name:
RUSSELL
Provider Middle Name:
VAL
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
SR.
Provider Credential Text:
DC
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:
1790739324
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
12/29/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
11616 S STATE ST
Provider Second Line Business Mailing Address:
SUITE 1502
Provider Business Mailing Address City Name:
DRAPER
Provider Business Mailing Address State Name:
UT
Provider Business Mailing Address Postal Code:
84020-7125
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
801-571-2200
Provider Business Mailing Address Fax Number:
801-816-1048

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
11616 S STATE ST
Provider Second Line Business Practice Location Address:
SUITE 1502
Provider Business Practice Location Address City Name:
DRAPER
Provider Business Practice Location Address State Name:
UT
Provider Business Practice Location Address Postal Code:
84020-7125
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
801-571-2200
Provider Business Practice Location Address Fax Number:
801-816-1048
Provider Enumeration Date:
05/19/2006

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: 111N00000X , with the licence number:  172703-1202 , 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: 870560087 . This is a "SELECTHEALTH" identifier , issued by the state of ( UT ) . This identifiers is of the category "OTHER".
  • Identifier: DE0098 . This is a "PALMETTO GBA - RAILROAD" identifier , issued by the state of ( UT ) . This identifiers is of the category "OTHER".
  • Identifier: 0004464362 . This is a "AETNA" identifier , issued by the state of ( UT ) . This identifiers is of the category "OTHER".
  • Identifier: 870560087 . This is a "UNITED HEALTH CARE" identifier , issued by the state of ( UT ) . This identifiers is of the category "OTHER".
  • Identifier: 870560087 . This is a "MAIL HANDLERS" identifier , issued by the state of ( UT ) . This identifiers is of the category "OTHER".
  • Identifier: 870560087-001 . This is a "MBA" identifier , issued by the state of ( UT ) . This identifiers is of the category "OTHER".




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