1528010451 NPI number — HOSPITAL CORPORATION OF UTAH

Table of content: MUKHTAR AHMAD KHAN MD (NPI 1306948435)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1528010451 NPI number — HOSPITAL CORPORATION OF UTAH

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
HOSPITAL CORPORATION OF UTAH
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:
LAKEVIEW HOSPITAL
Provider Other Organization Name Type Code:
3
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:
1528010451
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
06/03/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
630 MEDICAL DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BOUNTIFUL
Provider Business Mailing Address State Name:
UT
Provider Business Mailing Address Postal Code:
84010-4908
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
801-299-2503
Provider Business Mailing Address Fax Number:
801-299-2534

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
630 MEDICAL DR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BOUNTIFUL
Provider Business Practice Location Address State Name:
UT
Provider Business Practice Location Address Postal Code:
84010-4908
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
801-299-2503
Provider Business Practice Location Address Fax Number:
801-299-2534
Provider Enumeration Date:
05/17/2006

Additional Information

Authorized Official

Authorized Official Last Name:
DALTON
Authorized Official First Name:
WAYNE
Authorized Official Middle Name:
Authorized Official Title or Position:
CFO
Authorized Official Telephone Number:
801-299-2503

Provider Taxonomy Codes

  • Taxonomy code: 282N00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 210603 , issued by the state of ( OR ) . This identifiers is of the category "MEDICAID".
  • Identifier: 0418522 , issued by the state of ( MT ) . This identifiers is of the category "MEDICAID".
  • Identifier: 109092500 , issued by the state of ( WY ) . This identifiers is of the category "MEDICAID".
  • Identifier: 002992000 , issued by the state of ( ID ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1188940 , issued by the state of ( NV ) . This identifiers is of the category "MEDICAID".
  • Identifier: HS046IP , issued by the state of ( AK ) . This identifiers is of the category "MEDICAID".




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