1578819488 NPI number — UTAH VALLEY HEARING AND BALANCE LLC

Table of content: (NPI 1578819488)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1578819488 NPI number — UTAH VALLEY HEARING AND BALANCE LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
UTAH VALLEY HEARING AND BALANCE LLC
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:
1578819488
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
09/09/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
672 W 400 S
Provider Second Line Business Mailing Address:
204
Provider Business Mailing Address City Name:
SPRINGVILLE
Provider Business Mailing Address State Name:
UT
Provider Business Mailing Address Postal Code:
84663-3157
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
801-655-3118
Provider Business Mailing Address Fax Number:
801-704-9441

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
672 W 400 S
Provider Second Line Business Practice Location Address:
204
Provider Business Practice Location Address City Name:
SPRINGVILLE
Provider Business Practice Location Address State Name:
UT
Provider Business Practice Location Address Postal Code:
84663-3157
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
801-655-3118
Provider Business Practice Location Address Fax Number:
801-704-9941
Provider Enumeration Date:
07/28/2012

Additional Information

Authorized Official

Authorized Official Last Name:
BIRD
Authorized Official First Name:
RICHARD
Authorized Official Middle Name:
MONEY
Authorized Official Title or Position:
DOCTOR
Authorized Official Telephone Number:
801-655-3118

Provider Taxonomy Codes

  • Taxonomy code: 231H00000X , with the licence number:  6082321-4101 , 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: 9082 . This is a "PASS CODE" identifier . This identifiers is of the category "OTHER".




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