1396709903 NPI number — WILLIAM PRESTON MD, INC

Table of content: (NPI 1396709903)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1396709903 NPI number — WILLIAM PRESTON MD, INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
WILLIAM PRESTON MD, INC
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:
1396709903
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
155 N 400 W
Provider Second Line Business Mailing Address:
SUITE B6
Provider Business Mailing Address City Name:
OREM
Provider Business Mailing Address State Name:
UT
Provider Business Mailing Address Postal Code:
84057-1909
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
801-224-1300
Provider Business Mailing Address Fax Number:
801-225-3236

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
155 N 400 W
Provider Second Line Business Practice Location Address:
SUITE B6
Provider Business Practice Location Address City Name:
OREM
Provider Business Practice Location Address State Name:
UT
Provider Business Practice Location Address Postal Code:
84057-1909
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
801-224-1300
Provider Business Practice Location Address Fax Number:
801-225-3236
Provider Enumeration Date:
04/12/2006

Additional Information

Authorized Official

Authorized Official Last Name:
PRESTON
Authorized Official First Name:
WILLIAM
Authorized Official Middle Name:
D.
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
801-224-1300

Provider Taxonomy Codes

  • Taxonomy code: 207Q00000X , with the licence number:  163269-1205 , 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: 528276421000 , issued by the state of ( UT ) . This identifiers is of the category "MEDICAID".




Copyright © 2007-2025 www.npivalidator.com