1003986613 NPI number — CITY OF ROY CORP.

Table of content: (NPI 1003986613)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1003986613 NPI number — CITY OF ROY CORP.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CITY OF ROY CORP.
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:
6
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:
1003986613
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
11/03/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
5051 S 1900 W
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ROY
Provider Business Mailing Address State Name:
UT
Provider Business Mailing Address Postal Code:
84067-2936
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
801-774-1080
Provider Business Mailing Address Fax Number:
801-774-1059

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
5051 S 1900 W
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ROY
Provider Business Practice Location Address State Name:
UT
Provider Business Practice Location Address Postal Code:
84067-2936
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
801-774-1080
Provider Business Practice Location Address Fax Number:
801-774-1059
Provider Enumeration Date:
11/09/2006

Additional Information

Authorized Official

Authorized Official Last Name:
FROERER
Authorized Official First Name:
ERIC
Authorized Official Middle Name:
J
Authorized Official Title or Position:
DEPUTY CHIEF
Authorized Official Telephone Number:
801-774-1080

Provider Taxonomy Codes

  • Taxonomy code: 3416L0300X , with the licence number:  2902L , 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: 990001909006 , issued by the state of ( UT ) . This identifiers is of the category "MEDICAID".




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