1598704983 NPI number — MR. RANDY JOE FORSYTH P.T.

Table of content: MR. RANDY JOE FORSYTH P.T. (NPI 1598704983)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1598704983 NPI number — MR. RANDY JOE FORSYTH P.T.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
FORSYTH
Provider First Name:
RANDY
Provider Middle Name:
JOE
Provider Name Prefix Text:
MR.
Provider Name Suffix Text:
Provider Credential Text:
P.T.
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:
1598704983
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/07/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1335 NORTHFIELD RD
Provider Second Line Business Mailing Address:
SUITE 300
Provider Business Mailing Address City Name:
CEDAR CITY
Provider Business Mailing Address State Name:
UT
Provider Business Mailing Address Postal Code:
84720-9390
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
435-865-1902
Provider Business Mailing Address Fax Number:
435-586-5176

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1335 NORTHFIELD RD
Provider Second Line Business Practice Location Address:
SUITE 300
Provider Business Practice Location Address City Name:
CEDAR CITY
Provider Business Practice Location Address State Name:
UT
Provider Business Practice Location Address Postal Code:
84720-9390
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
435-865-1902
Provider Business Practice Location Address Fax Number:
435-586-5176
Provider Enumeration Date:
06/04/2006

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: 225100000X , with the licence number:  121023-2401 , 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: 638842 . This is a "DMBA" identifier , issued by the state of ( UT ) . This identifiers is of the category "OTHER".
  • Identifier: 650019321 . This is a "RAILROAD MEDICARE" identifier , issued by the state of ( UT ) . This identifiers is of the category "OTHER".
  • Identifier: 9212023202001 . This is a "BCBS PPO" identifier , issued by the state of ( UT ) . This identifiers is of the category "OTHER".
  • Identifier: 6480151 . This is a "UNITED HEALTH CARE" identifier , issued by the state of ( UT ) . This identifiers is of the category "OTHER".
  • Identifier: 0174004 . This is a "WASHINGTON STATE LABOR" identifier , issued by the state of ( UT ) . This identifiers is of the category "OTHER".
  • Identifier: 5088449 . This is a "AETNA" identifier , issued by the state of ( UT ) . This identifiers is of the category "OTHER".
  • Identifier: 59792 . This is a "PEHP" identifier , issued by the state of ( UT ) . This identifiers is of the category "OTHER".
  • Identifier: PRA03874 . This is a "MOLINA" identifier , issued by the state of ( UT ) . This identifiers is of the category "OTHER".
  • Identifier: 870656237RF2 . This is a "EDUCATORS MUTUAL" identifier , issued by the state of ( UT ) . This identifiers is of the category "OTHER".
  • Identifier: 9212102320001 . This is a "BCBS TRADITIONAL" identifier , issued by the state of ( UT ) . This identifiers is of the category "OTHER".
  • Identifier: 107007215101 . This is a "SELECT HEALTH" identifier , issued by the state of ( UT ) . This identifiers is of the category "OTHER".
  • Identifier: 876542 . This is a "ARIZONA PHYSICIANS HEALTH" identifier , issued by the state of ( UT ) . This identifiers is of the category "OTHER".
  • Identifier: 034181 . This is a "SELECT MED" identifier , issued by the state of ( UT ) . This identifiers is of the category "OTHER".




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