1992009799 NPI number — SLEEP AND LUNG CLINIC OF UTAH, INC.

Table of content: CLAIRE STICKNEY DINE (NPI 1316722762)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1992009799 NPI number — SLEEP AND LUNG CLINIC OF UTAH, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
SLEEP AND LUNG CLINIC OF UTAH, INC.
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:
1992009799
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/05/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
5801 FASHION BLVD
Provider Second Line Business Mailing Address:
STE. 280
Provider Business Mailing Address City Name:
MURRAY
Provider Business Mailing Address State Name:
UT
Provider Business Mailing Address Postal Code:
84107-6159
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
801-260-5864
Provider Business Mailing Address Fax Number:
801-260-5865

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
5801 S. FASHION BLVD
Provider Second Line Business Practice Location Address:
STE. 280
Provider Business Practice Location Address City Name:
MURRAY
Provider Business Practice Location Address State Name:
UT
Provider Business Practice Location Address Postal Code:
84107-6159
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
801-260-5864
Provider Business Practice Location Address Fax Number:
801-260-5865
Provider Enumeration Date:
01/07/2011

Additional Information

Authorized Official

Authorized Official Last Name:
DIENHART
Authorized Official First Name:
DAVID
Authorized Official Middle Name:
G
Authorized Official Title or Position:
MEDICAL DIRECTOR
Authorized Official Telephone Number:
801-260-5864

Provider Taxonomy Codes

  • Taxonomy code: 207RP1001X , registered in the state of UT ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 207RP1001X , with the licence number: 277542-1205 , registered in the state of UT ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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





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