1568423879 NPI number — KENNETH R PINNA M.D.

Table of content: KENNETH R PINNA M.D. (NPI 1568423879)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1568423879 NPI number — KENNETH R PINNA M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
PINNA
Provider First Name:
KENNETH
Provider Middle Name:
R
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
M.D.
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:
1568423879
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
04/06/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
515 S 300 E STE 101
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SAINT GEORGE
Provider Business Mailing Address State Name:
UT
Provider Business Mailing Address Postal Code:
84770-3931
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
435-688-1128
Provider Business Mailing Address Fax Number:
435-673-4045

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
515 S 300 E, STE 101
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SAINT GEORGE
Provider Business Practice Location Address State Name:
UT
Provider Business Practice Location Address Postal Code:
84770-3900
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
435-688-1128
Provider Business Practice Location Address Fax Number:
435-673-4045
Provider Enumeration Date:
03/28/2006

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: 174400000X , with the licence number:  541616501205 , 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: 9385678 . This is a "PRIVATE HEALTH CARE SYSTE" identifier , issued by the state of ( UT ) . This identifiers is of the category "OTHER".
  • Identifier: 0200037 . This is a "UNITED HEALTH CARE" identifier , issued by the state of ( UT ) . This identifiers is of the category "OTHER".
  • Identifier: 81217 . This is a "PUBLIC EMPLOYEES HEALTH P" identifier , issued by the state of ( UT ) . This identifiers is of the category "OTHER".
  • Identifier: 107023322102 . This is a "INTERMOUNTAIN HEALTH CARE" identifier , issued by the state of ( UT ) . This identifiers is of the category "OTHER".
  • Identifier: 233306 . This is a "ALTIUS" identifier , issued by the state of ( UT ) . This identifiers is of the category "OTHER".
  • Identifier: 1568423879 , issued by the state of ( UT ) . This identifiers is of the category "MEDICAID".
  • Identifier: 200355426KRP . This is a "EDUCATORS MUTUAL" identifier , issued by the state of ( UT ) . This identifiers is of the category "OTHER".
  • Identifier: 7358374 . This is a "AETNA" identifier , issued by the state of ( UT ) . This identifiers is of the category "OTHER".
  • Identifier: 54161501202001 . This is a "BLUE CROSS/ BLUE SHIELD" identifier , issued by the state of ( UT ) . This identifiers is of the category "OTHER".
  • Identifier: 5595330 . This is a "FIRST HEALTH" identifier , issued by the state of ( UT ) . This identifiers is of the category "OTHER".




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