1104880178 NPI number — EILEEN E JOYCE M.D.

Table of content: EILEEN E JOYCE M.D. (NPI 1104880178)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1104880178 NPI number — EILEEN E JOYCE M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
JOYCE
Provider First Name:
EILEEN
Provider Middle Name:
E
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
M.D.
Provider Gender Code:
F

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:
1104880178
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
05/12/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
150 WEST 100 NORTH
Provider Second Line Business Mailing Address:
GL02
Provider Business Mailing Address City Name:
VERNAL
Provider Business Mailing Address State Name:
UT
Provider Business Mailing Address Postal Code:
84078
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
435-789-6962
Provider Business Mailing Address Fax Number:
435-789-6961

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
150 WEST 100 NORTH
Provider Second Line Business Practice Location Address:
GL02
Provider Business Practice Location Address City Name:
VERNAL
Provider Business Practice Location Address State Name:
UT
Provider Business Practice Location Address Postal Code:
84078
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
435-789-6962
Provider Business Practice Location Address Fax Number:
435-789-6961
Provider Enumeration Date:
04/14/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207V00000X , with the licence number:  187497 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207VX0000X , with the licence number: DR.0056060 , registered in the state of CO ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 15218 . This is a "MVP PROVIDER #" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 160026706 . This is a "RAILROAD MEDICARE" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 53730071 , issued by the state of ( CO ) . This identifiers is of the category "MEDICAID".
  • Identifier: 10000992 . This is a "CDPHP PROVIDER #" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 01473541 , issued by the state of ( NY ) . This identifiers is of the category "MEDICAID".




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