1427187582 NPI number — CACHE VALLEY CANCER TREATMENT &RESEARCH CLINIC PC

Table of content: (NPI 1427187582)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1427187582 NPI number — CACHE VALLEY CANCER TREATMENT &RESEARCH CLINIC PC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CACHE VALLEY CANCER TREATMENT &RESEARCH CLINIC PC
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:
1427187582
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
11/03/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1281 N 600 E
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LOGAN
Provider Business Mailing Address State Name:
UT
Provider Business Mailing Address Postal Code:
84341-6988
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
435-752-5999
Provider Business Mailing Address Fax Number:
435-752-5551

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1281 N 600 E
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LOGAN
Provider Business Practice Location Address State Name:
UT
Provider Business Practice Location Address Postal Code:
84341-6988
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
435-752-5999
Provider Business Practice Location Address Fax Number:
435-752-5551
Provider Enumeration Date:
03/05/2007

Additional Information

Authorized Official

Authorized Official Last Name:
BEN-JACOB
Authorized Official First Name:
ALI
Authorized Official Middle Name:
Authorized Official Title or Position:
DOCTOR
Authorized Official Telephone Number:
435-752-5999

Provider Taxonomy Codes

  • Taxonomy code: 174400000X , with the licence number:  292373-1205 , 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: 1427187582 . This is a "GROUP NATIONAL PROVIDER IDENTIFIER" identifier , issued by the state of ( UT ) . This identifiers is of the category "OTHER".




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