1336318666 NPI number — UTAH VALLEY OBSTETRICAL ULTRA SOUND

Table of content: (NPI 1336318666)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1336318666 NPI number — UTAH VALLEY OBSTETRICAL ULTRA SOUND

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
UTAH VALLEY OBSTETRICAL ULTRA SOUND
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:
1336318666
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
01/04/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 971388
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
OREM
Provider Business Mailing Address State Name:
UT
Provider Business Mailing Address Postal Code:
84097-1388
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
801-225-5407
Provider Business Mailing Address Fax Number:
801-225-5623

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1055 N 300 W STE 303
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
PROVO
Provider Business Practice Location Address State Name:
UT
Provider Business Practice Location Address Postal Code:
84604-3373
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
801-357-7377
Provider Business Practice Location Address Fax Number:
801-765-8805
Provider Enumeration Date:
02/20/2008

Additional Information

Authorized Official

Authorized Official Last Name:
LAYTON
Authorized Official First Name:
JODIE
Authorized Official Middle Name:
Authorized Official Title or Position:
OWNER/ULTRASONOGRAPHER
Authorized Official Telephone Number:
801-357-7377

Provider Taxonomy Codes

  • Taxonomy code: 2471S1302X , with the licence number:  76101 , 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)





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