1093948010 NPI number — W BRYCE COOK

Table of content: (NPI 1093948010)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1093948010 NPI number — W BRYCE COOK

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
W BRYCE COOK
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:
1093948010
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/05/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
550 E 1400 N
Provider Second Line Business Mailing Address:
#B
Provider Business Mailing Address City Name:
LOGAN
Provider Business Mailing Address State Name:
UT
Provider Business Mailing Address Postal Code:
84341-2406
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
435-752-9011
Provider Business Mailing Address Fax Number:
435-752-7159

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
990 MEDICAL DR
Provider Second Line Business Practice Location Address:
#U3
Provider Business Practice Location Address City Name:
BRIGHAM CITY
Provider Business Practice Location Address State Name:
UT
Provider Business Practice Location Address Postal Code:
84302-4713
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
435-734-9623
Provider Business Practice Location Address Fax Number:
435-752-7159
Provider Enumeration Date:
08/25/2009

Additional Information

Authorized Official

Authorized Official Last Name:
COOK
Authorized Official First Name:
W
Authorized Official Middle Name:
BRYCE
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
435-752-9011

Provider Taxonomy Codes

  • Taxonomy code: 213ES0103X , with the licence number:  1032580501 , 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