1508851635 NPI number — DWIGHT A RIGBY MD

Table of content: DWIGHT A RIGBY MD (NPI 1508851635)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1508851635 NPI number — DWIGHT A RIGBY MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
RIGBY
Provider First Name:
DWIGHT
Provider Middle Name:
A
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MD
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:
1508851635
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/07/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 27128
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:
84127-0128
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
801-387-3400
Provider Business Mailing Address Fax Number:
801-387-3420

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4403 HARRISON BLVD
Provider Second Line Business Practice Location Address:
STE 3400
Provider Business Practice Location Address City Name:
OGDEN
Provider Business Practice Location Address State Name:
UT
Provider Business Practice Location Address Postal Code:
84403-3271
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
801-387-3400
Provider Business Practice Location Address Fax Number:
801-387-3420
Provider Enumeration Date:
09/14/2005

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: 207RC0000X , with the licence number:  165314-1205 , 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: 25-00434 . This is a "UNITED HEALTHCARE" identifier , issued by the state of ( UT ) . This identifiers is of the category "OTHER".
  • Identifier: PR00930 , issued by the state of ( UT ) . This identifiers is of the category "MEDICAID".
  • Identifier: 20498551300106465 , issued by the state of ( UT ) . This identifiers is of the category "MEDICAID".
  • Identifier: 3379936 . This is a "CIGNA" identifier , issued by the state of ( UT ) . This identifiers is of the category "OTHER".
  • Identifier: QM0000016781 . This is a "ALTIUS" identifier , issued by the state of ( UT ) . This identifiers is of the category "OTHER".
  • Identifier: 807609800 , issued by the state of ( ID ) . This identifiers is of the category "MEDICAID".
  • Identifier: DURB1 . This is a "BC OF IDAHO" identifier , issued by the state of ( ID ) . This identifiers is of the category "OTHER".
  • Identifier: 20498551384403A004 . This is a "TRICARE" identifier , issued by the state of ( UT ) . This identifiers is of the category "OTHER".
  • Identifier: 204985513DAR . This is a "EMIA" identifier , issued by the state of ( UT ) . This identifiers is of the category "OTHER".
  • Identifier: 20832 . This is a "DMBA" identifier , issued by the state of ( UT ) . This identifiers is of the category "OTHER".
  • Identifier: 90218 . This is a "PEHP" identifier , issued by the state of ( UT ) . This identifiers is of the category "OTHER".
  • Identifier: 107006021105 . This is a "SELECTHEALTH" identifier , issued by the state of ( UT ) . This identifiers is of the category "OTHER".
  • Identifier: 611697900 . This is a "USDOL" identifier , issued by the state of ( UT ) . This identifiers is of the category "OTHER".




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