1003139742 NPI number — MR. NORWOOD E. PENDLETON NBC-HIS MS

Table of content: MR. NORWOOD E. PENDLETON NBC-HIS MS (NPI 1003139742)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1003139742 NPI number — MR. NORWOOD E. PENDLETON NBC-HIS MS

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
PENDLETON
Provider First Name:
NORWOOD
Provider Middle Name:
E.
Provider Name Prefix Text:
MR.
Provider Name Suffix Text:
Provider Credential Text:
NBC-HIS MS
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
HEBDON
Provider Other First Name:
TRENT
Provider Other Middle Name:
Provider Other Name Prefix Text:
MR.
Provider Other Name Suffix Text:
Provider Other Credential Text:
NBA-HIS-BS
Provider Other Last Name Type Code:
2

NPI Number Information

NPI Number:
1003139742
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/09/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1410 N HILL FIELD RD STE 5
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LAYTON
Provider Business Mailing Address State Name:
UT
Provider Business Mailing Address Postal Code:
84041-5056
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
801-668-6479
Provider Business Mailing Address Fax Number:
801-317-4076

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1410 N HILL FIELD RD STE 5
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LAYTON
Provider Business Practice Location Address State Name:
UT
Provider Business Practice Location Address Postal Code:
84041-5056
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
801-668-6479
Provider Business Practice Location Address Fax Number:
801-317-4076
Provider Enumeration Date:
03/09/2010

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: 237700000X , with the licence number:  1061044601 , 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)





Copyright © 2007-2025 www.npivalidator.com