1154334472 NPI number — PLYMOUTH TOWN CORPORATION

Table of content: (NPI 1154334472)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1154334472 NPI number — PLYMOUTH TOWN CORPORATION

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
PLYMOUTH TOWN CORPORATION
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:
1154334472
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/07/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 130
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
PLYMOUTH
Provider Business Mailing Address State Name:
UT
Provider Business Mailing Address Postal Code:
84330-0130
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
435-239-7278
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
20120 N 5200 W
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
PLYMOUTH
Provider Business Practice Location Address State Name:
UT
Provider Business Practice Location Address Postal Code:
84330
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
435-239-7278
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
08/15/2006

Additional Information

Authorized Official

Authorized Official Last Name:
ANDERSON
Authorized Official First Name:
JERIMY
Authorized Official Middle Name:
R
Authorized Official Title or Position:
CHIEF
Authorized Official Telephone Number:
435-239-7278

Provider Taxonomy Codes

  • Taxonomy code: 3416L0300X , with the licence number:  0205L , 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)

  • Identifier: U000073129 . This is a "MEDICARE TYPE UNSPECIFIED" identifier , issued by the state of ( UT ) . This identifiers is of the category "OTHER".




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