1437331592 NPI number — DR DIANA D BANKS, LLC

Table of content: (NPI 1437331592)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1437331592 NPI number — DR DIANA D BANKS, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
DR DIANA D BANKS, 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:
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:
1437331592
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/09/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 95970
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SOUTH JORDAN
Provider Business Mailing Address State Name:
UT
Provider Business Mailing Address Postal Code:
84095-0970
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
801-352-9500
Provider Business Mailing Address Fax Number:
801-352-9502

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
5323 SOUTH 120 WEST
Provider Second Line Business Practice Location Address:
SUITE 201
Provider Business Practice Location Address City Name:
SALT LAKE CITY
Provider Business Practice Location Address State Name:
UT
Provider Business Practice Location Address Postal Code:
84107
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
801-508-5945
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
11/30/2007

Additional Information

Authorized Official

Authorized Official Last Name:
DAWSON
Authorized Official First Name:
JENNIFER
Authorized Official Middle Name:
Authorized Official Title or Position:
CLINIC MANAGER
Authorized Official Telephone Number:
801-208-5945

Provider Taxonomy Codes

  • Taxonomy code: 207T00000X , with the licence number:  181340-1205 , 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: 1437331592 , issued by the state of ( UT ) . This identifiers is of the category "MEDICAID".
  • Identifier: 130009566 . This is a "RAILROAD MEDICARE" identifier , issued by the state of ( UT ) . This identifiers is of the category "OTHER".




Copyright © 2007-2025 www.npivalidator.com