1508926551 NPI number — SOUTH VALLEY EAR NOSE AND THROAT ASSOCIATES, PLLC

Table of content: (NPI 1508926551)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1508926551 NPI number — SOUTH VALLEY EAR NOSE AND THROAT ASSOCIATES, PLLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
SOUTH VALLEY EAR NOSE AND THROAT ASSOCIATES, PLLC
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:
1508926551
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
06/30/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3584 W. 9000 S.
Provider Second Line Business Mailing Address:
SUITE 311
Provider Business Mailing Address City Name:
WEST JORDAN
Provider Business Mailing Address State Name:
UT
Provider Business Mailing Address Postal Code:
84088-4775
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
801-566-8304
Provider Business Mailing Address Fax Number:
801-566-8330

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3584 W. 9000 S.
Provider Second Line Business Practice Location Address:
SUITE 311
Provider Business Practice Location Address City Name:
WEST JORDAN
Provider Business Practice Location Address State Name:
UT
Provider Business Practice Location Address Postal Code:
84088-4775
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
801-566-8304
Provider Business Practice Location Address Fax Number:
801-566-8330
Provider Enumeration Date:
12/11/2006

Additional Information

Authorized Official

Authorized Official Last Name:
MEADS
Authorized Official First Name:
GARNER
Authorized Official Middle Name:
B.
Authorized Official Title or Position:
MANAGING PARTNER
Authorized Official Telephone Number:
801-566-8304

Provider Taxonomy Codes

  • Taxonomy code: 207Y00000X , with the licence number:  163937-1205 , 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)





Copyright © 2007-2025 www.npivalidator.com