1396985230 NPI number — JOHN L GRIFFITH

Table of content: (NPI 1396985230)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1396985230 NPI number — JOHN L GRIFFITH

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
JOHN L GRIFFITH
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:
1396985230
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/05/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
150 W 100 N STE S104
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
VERNAL
Provider Business Mailing Address State Name:
UT
Provider Business Mailing Address Postal Code:
84078-2036
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
435-781-1099
Provider Business Mailing Address Fax Number:
435-781-1090

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
150 W 100 N STE S104
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
VERNAL
Provider Business Practice Location Address State Name:
UT
Provider Business Practice Location Address Postal Code:
84078-2036
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
435-781-1099
Provider Business Practice Location Address Fax Number:
435-781-1090
Provider Enumeration Date:
03/05/2009

Additional Information

Authorized Official

Authorized Official Last Name:
GRIFFITH
Authorized Official First Name:
JOHN
Authorized Official Middle Name:
L
Authorized Official Title or Position:
OBGYN
Authorized Official Telephone Number:
435-781-1099

Provider Taxonomy Codes

  • Taxonomy code: 261Q00000X , with the licence number:  61485681205 , 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: 518680715001 , issued by the state of ( UT ) . This identifiers is of the category "MEDICAID".




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