1043465032 NPI number — DARCY H. WOLSEY MD LLC

Table of content: (NPI 1043465032)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1043465032 NPI number — DARCY H. WOLSEY MD LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
DARCY H. WOLSEY MD LLC
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:
1043465032
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
11/18/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
409 3RD AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SALT LAKE CITY
Provider Business Mailing Address State Name:
UT
Provider Business Mailing Address Postal Code:
84103-2648
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
801-750-1967
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1025 E 3300 S
Provider Second Line Business Practice Location Address:
#B
Provider Business Practice Location Address City Name:
SLC
Provider Business Practice Location Address State Name:
UT
Provider Business Practice Location Address Postal Code:
84106-2849
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
801-281-2020
Provider Business Practice Location Address Fax Number:
801-487-3687
Provider Enumeration Date:
11/18/2008

Additional Information

Authorized Official

Authorized Official Last Name:
WOLSEY
Authorized Official First Name:
DARCY
Authorized Official Middle Name:
HUNT
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
801-750-1967

Provider Taxonomy Codes

  • Taxonomy code: 261QS0132X , with the licence number:  2921121205 , 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