1588973978 NPI number — ALMA PARKER MD PC

Table of content: (NPI 1588973978)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1588973978 NPI number — ALMA PARKER MD PC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ALMA PARKER MD PC
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:
1588973978
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
12/20/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
175 N 100 W
Provider Second Line Business Mailing Address:
STE 205C
Provider Business Mailing Address City Name:
VERNAL
Provider Business Mailing Address State Name:
UT
Provider Business Mailing Address Postal Code:
84078-2049
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
435-781-6300
Provider Business Mailing Address Fax Number:
435-781-6301

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
175 N 100 W
Provider Second Line Business Practice Location Address:
STE 205C
Provider Business Practice Location Address City Name:
VERNAL
Provider Business Practice Location Address State Name:
UT
Provider Business Practice Location Address Postal Code:
84078-2049
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
435-781-6300
Provider Business Practice Location Address Fax Number:
435-781-6301
Provider Enumeration Date:
10/01/2010

Additional Information

Authorized Official

Authorized Official Last Name:
PARKER
Authorized Official First Name:
ALMA
Authorized Official Middle Name:
L
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
435-781-6300

Provider Taxonomy Codes

  • Taxonomy code: 207Q00000X , with the licence number:  77313971205 , 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: 01061964 . This is a "OWNER'S DOB" identifier , issued by the state of ( UT ) . This identifiers is of the category "OTHER".




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