1245505973 NPI number — UTAH VALLEY URGENT CARE PLLC

Table of content: (NPI 1245505973)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1245505973 NPI number — UTAH VALLEY URGENT CARE PLLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
UTAH VALLEY URGENT CARE PLLC
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:
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:
1245505973
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/13/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
127 E MAIN ST
Provider Second Line Business Mailing Address:
SUITE E
Provider Business Mailing Address City Name:
LEHI
Provider Business Mailing Address State Name:
UT
Provider Business Mailing Address Postal Code:
84043-2288
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
801-766-9822
Provider Business Mailing Address Fax Number:
801-766-9441

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
960 W 800 N
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
OREM
Provider Business Practice Location Address State Name:
UT
Provider Business Practice Location Address Postal Code:
84057-3626
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
801-766-9822
Provider Business Practice Location Address Fax Number:
801-766-9441
Provider Enumeration Date:
03/13/2012

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
HOUGH
Authorized Official First Name:
WILLIAM
Authorized Official Middle Name:
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
801-766-9822

Provider Taxonomy Codes

  • Taxonomy code: 207Q00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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