1023637675 NPI number — SANTAQUIN MARKET, INC.

Table of content: LORRAINE RODRIGUEZ MSN,FNP,BSN RN (NPI 1326412255)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1023637675 NPI number — SANTAQUIN MARKET, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
SANTAQUIN MARKET, 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:
1023637675
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/15/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
586 N MAIN ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
PAYSON
Provider Business Mailing Address State Name:
UT
Provider Business Mailing Address Postal Code:
84651-3428
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
801-465-2343
Provider Business Mailing Address Fax Number:
801-465-0856

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
110 N. 400 E.
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SANTAQUIN
Provider Business Practice Location Address State Name:
UT
Provider Business Practice Location Address Postal Code:
84655
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
801-465-2343
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
04/14/2020

Additional Information

Authorized Official

Authorized Official Last Name:
MEASOM
Authorized Official First Name:
HAROLD
Authorized Official Middle Name:
Authorized Official Title or Position:
MANAGER
Authorized Official Telephone Number:
801-465-2343

Provider Taxonomy Codes

  • Taxonomy code: 3336C0003X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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