1255676920 NPI number — NORTHPOINTE SURGICAL CENTER, LLC

Table of content: (NPI 1255676920)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1255676920 NPI number — NORTHPOINTE SURGICAL CENTER, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
NORTHPOINTE SURGICAL CENTER, LLC
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:
1255676920
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/07/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2326 N 400 E STE 100
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
TOOELE
Provider Business Mailing Address State Name:
UT
Provider Business Mailing Address Postal Code:
84074-3460
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
435-843-0180
Provider Business Mailing Address Fax Number:
435-843-0181

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2326 N 400 E STE 100
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
TOOELE
Provider Business Practice Location Address State Name:
UT
Provider Business Practice Location Address Postal Code:
84074-3460
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
435-843-0180
Provider Business Practice Location Address Fax Number:
435-843-0181
Provider Enumeration Date:
12/06/2012

Additional Information

Authorized Official

Authorized Official Last Name:
MELODY
Authorized Official First Name:
COMBS
Authorized Official Middle Name:
JO
Authorized Official Title or Position:
ADMINISTRATOR
Authorized Official Telephone Number:
435-843-0180

Provider Taxonomy Codes

  • Taxonomy code: 261QA1903X , 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: 6806D882440 . This is a "GENERAL LIABILITY" identifier , issued by the state of ( UT ) . This identifiers is of the category "OTHER".
  • Identifier: 46C0001058 . This is a "MEDICARE CERTIFICATION NUMBER" identifier , issued by the state of ( UT ) . This identifiers is of the category "OTHER".
  • Identifier: U000086465 . This is a "NORIDIAN PTAN NUMBER" identifier , issued by the state of ( UT ) . This identifiers is of the category "OTHER".
  • Identifier: 2014-ASF-UT000647 . This is a "PROFESSIONAL LICENSE" identifier , issued by the state of ( UT ) . This identifiers is of the category "OTHER".
  • Identifier: 103541 . This is a "AAAHC - ACCREDITATION" identifier , issued by the state of ( UT ) . This identifiers is of the category "OTHER".
  • Identifier: 8929365-17014 . This is a "PROFESSIONAL LICENSE PHARMACY CLASS B" identifier , issued by the state of ( UT ) . This identifiers is of the category "OTHER".
  • Identifier: 6194 . This is a "BUSINESS LICENSE - TOOELE" identifier , issued by the state of ( UT ) . This identifiers is of the category "OTHER".
  • Identifier: 4310 . This is a "X-RAY LICENSE NUMBER" identifier , issued by the state of ( UT ) . This identifiers is of the category "OTHER".
  • Identifier: 46D2067524 . This is a "CLIA" identifier , issued by the state of ( UT ) . This identifiers is of the category "OTHER".
  • Identifier: 8929365-8913 . This is a "PROFESSIONAL LICENSE CONTROLLED SUBSTANCE LICENSE" identifier , issued by the state of ( UT ) . This identifiers is of the category "OTHER".
  • Identifier: UT900010 . This is a "MEDICAL MALPRACTICE" identifier , issued by the state of ( UT ) . This identifiers is of the category "OTHER".




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