1922275999 NPI number — LANCE R BRYCE

Table of content: (NPI 1922275999)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1922275999 NPI number — LANCE R BRYCE

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
LANCE R BRYCE
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:
CANYON SURGICAL CLINIC
Provider Other Organization Name Type Code:
3
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:
1922275999
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/26/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 268
Provider Second Line Business Mailing Address:
SUITE
Provider Business Mailing Address City Name:
BOUNTIFUL
Provider Business Mailing Address State Name:
UT
Provider Business Mailing Address Postal Code:
84011-0268
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
801-951-2349
Provider Business Mailing Address Fax Number:
801-951-2389

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
984 S 500 W
Provider Second Line Business Practice Location Address:
STE 2
Provider Business Practice Location Address City Name:
BRIGHAM CITY
Provider Business Practice Location Address State Name:
UT
Provider Business Practice Location Address Postal Code:
84302-3604
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
801-951-2349
Provider Business Practice Location Address Fax Number:
801-951-2389
Provider Enumeration Date:
05/09/2008

Additional Information

Authorized Official

Authorized Official Last Name:
BRYCE
Authorized Official First Name:
LANCE
Authorized Official Middle Name:
R
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
801-951-2349

Provider Taxonomy Codes

  • Taxonomy code: 208600000X , with the licence number:  81409 , registered in the state of AZ ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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