1164579355 NPI number — COUNTY OF SALT LAKE

Table of content: (NPI 1164579355)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1164579355 NPI number — COUNTY OF SALT LAKE

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
COUNTY OF SALT LAKE
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:
SALT LAKE COUNTY CORPORATION
Provider Other Organization Name Type Code:
3
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:
1164579355
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
09/16/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2001 S STATE ST
Provider Second Line Business Mailing Address:
S1500
Provider Business Mailing Address City Name:
SALT LAKE CITY
Provider Business Mailing Address State Name:
UT
Provider Business Mailing Address Postal Code:
84190-2300
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
801-468-2454
Provider Business Mailing Address Fax Number:
801-468-2852

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1992 S 200 E
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SALT LAKE CITY
Provider Business Practice Location Address State Name:
UT
Provider Business Practice Location Address Postal Code:
84115-2459
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
801-468-2454
Provider Business Practice Location Address Fax Number:
801-468-2838
Provider Enumeration Date:
01/03/2007

Additional Information

Authorized Official

Authorized Official Last Name:
KEERS
Authorized Official First Name:
JESSICA
Authorized Official Middle Name:
Authorized Official Title or Position:
FISCAL MANAGER
Authorized Official Telephone Number:
801-468-2766

Provider Taxonomy Codes

  • Taxonomy code: 251B00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 251J00000X , with the licence number: 346865-3102 , registered in the state of UT ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 332B00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 332U00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: 000064172 . This is a "MEDICARE PTAN" identifier , issued by the state of ( UT ) . This identifiers is of the category "OTHER".
  • Identifier: 1164579335 . This is a "NATIONAL PROVIDER IDENTIF" identifier . This identifiers is of the category "OTHER".




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