1457440687 NPI number — NEIL FRISCHKNECHT OD

Table of content: NEIL FRISCHKNECHT OD (NPI 1457440687)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1457440687 NPI number — NEIL FRISCHKNECHT OD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
FRISCHKNECHT
Provider First Name:
NEIL
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
OD
Provider Gender Code:
M

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:
1457440687
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
05/23/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1901 PARKWAY BLVD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SALT LAKE CITY
Provider Business Mailing Address State Name:
UT
Provider Business Mailing Address Postal Code:
84119-2001
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
801-886-2020
Provider Business Mailing Address Fax Number:
801-954-0054

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3754 W 5400 S
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
KEARNS
Provider Business Practice Location Address State Name:
UT
Provider Business Practice Location Address Postal Code:
84118-3574
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
801-964-9911
Provider Business Practice Location Address Fax Number:
801-964-1810
Provider Enumeration Date:
10/12/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 152W00000X , with the licence number:  1092671601 , 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: 000009922 . This is a "MEDICARE STORE #16 PTAN" identifier , issued by the state of ( UT ) . This identifiers is of the category "OTHER".
  • Identifier: 000009841 . This is a "MEDICARE STORE #13 PTAN" identifier , issued by the state of ( UT ) . This identifiers is of the category "OTHER".
  • Identifier: 999000797009 , issued by the state of ( UT ) . This identifiers is of the category "MEDICAID".




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