1497928147 NPI number — TOTAL CONCEPT HEALTH CARE

Table of content: (NPI 1497928147)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1497928147 NPI number — TOTAL CONCEPT HEALTH CARE

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
TOTAL CONCEPT HEALTH CARE
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:
1497928147
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/02/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
920 N 200 W
Provider Second Line Business Mailing Address:
SUITE A
Provider Business Mailing Address City Name:
LOGAN
Provider Business Mailing Address State Name:
UT
Provider Business Mailing Address Postal Code:
84321-3200
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
435-750-0366
Provider Business Mailing Address Fax Number:
435-750-0377

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
920 N 200 W
Provider Second Line Business Practice Location Address:
SUITE A
Provider Business Practice Location Address City Name:
LOGAN
Provider Business Practice Location Address State Name:
UT
Provider Business Practice Location Address Postal Code:
84321-3200
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
435-750-0366
Provider Business Practice Location Address Fax Number:
435-750-0377
Provider Enumeration Date:
04/02/2008

Additional Information

Authorized Official

Authorized Official Last Name:
YOUNG
Authorized Official First Name:
DANEE
Authorized Official Middle Name:
S
Authorized Official Title or Position:
DOCTOR AND EXECUTIVE CHEIF
Authorized Official Telephone Number:
435-750-0366

Provider Taxonomy Codes

  • Taxonomy code: 207VG0400X , with the licence number:  183608-1205 , registered in the state of UT ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 208600000X , with the licence number: 183608-1205 , registered in the state of UT ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 553068427005 , issued by the state of ( UT ) . This identifiers is of the category "MEDICAID".




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