1093026056 NPI number — DARREN B. JENKINS, D.O.,P.C.

Table of content: (NPI 1093026056)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1093026056 NPI number — DARREN B. JENKINS, D.O.,P.C.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
DARREN B. JENKINS, D.O.,P.C.
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:
1093026056
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/22/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
6933 S 1300 W
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
WEST JORDAN
Provider Business Mailing Address State Name:
UT
Provider Business Mailing Address Postal Code:
84084-2554
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
801-542-8080
Provider Business Mailing Address Fax Number:
801-748-0423

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1561 W 7000 S
Provider Second Line Business Practice Location Address:
SUITE 200
Provider Business Practice Location Address City Name:
WEST JORDAN
Provider Business Practice Location Address State Name:
UT
Provider Business Practice Location Address Postal Code:
84084-3556
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
801-562-5300
Provider Business Practice Location Address Fax Number:
801-562-1883
Provider Enumeration Date:
06/24/2010

Additional Information

Authorized Official

Authorized Official Last Name:
JENKINS
Authorized Official First Name:
DARREN
Authorized Official Middle Name:
BOYD
Authorized Official Title or Position:
OWNER/PRESIDENT
Authorized Official Telephone Number:
801-562-5300

Provider Taxonomy Codes

  • Taxonomy code: 207Q00000X , with the licence number:  7540742-1204 , 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