1871948653 NPI number — TEYNOR PHYSICIANS GROUP PLLC

Table of content: (NPI 1871948653)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1871948653 NPI number — TEYNOR PHYSICIANS GROUP PLLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
TEYNOR PHYSICIANS GROUP PLLC
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:
1871948653
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
11/23/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
4538 S BROCKBANK DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MILLCREEK
Provider Business Mailing Address State Name:
UT
Provider Business Mailing Address Postal Code:
84124-3912
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
385-285-8350
Provider Business Mailing Address Fax Number:
516-531-8730

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2290 E 4500 S STE 180
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SALT LAKE CITY
Provider Business Practice Location Address State Name:
UT
Provider Business Practice Location Address Postal Code:
84117-4493
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
385-285-8350
Provider Business Practice Location Address Fax Number:
516-531-8730
Provider Enumeration Date:
04/28/2016

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
TEYNOR
Authorized Official First Name:
STEVEN
Authorized Official Middle Name:
VINCENT
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
385-285-8350

Provider Taxonomy Codes

  • Taxonomy code: 2084P0800X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)