1609254796 NPI number — MIDTOWN COMMUNITY HEALTH CENTER INC

Table of content: NAOMI SYMPHONY NOEL UYEDA (NPI 1811515489)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1609254796 NPI number — MIDTOWN COMMUNITY HEALTH CENTER INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
MIDTOWN COMMUNITY HEALTH CENTER INC
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:
6
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:
1609254796
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/16/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2240 ADAMS AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
OGDEN
Provider Business Mailing Address State Name:
UT
Provider Business Mailing Address Postal Code:
84401-1511
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
801-393-5355
Provider Business Mailing Address Fax Number:
801-394-4609

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
269 W 3300 S
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
OGDEN
Provider Business Practice Location Address State Name:
UT
Provider Business Practice Location Address Postal Code:
84401-8440
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
801-393-5355
Provider Business Practice Location Address Fax Number:
801-394-4609
Provider Enumeration Date:
05/11/2015

Additional Information

Authorized Official

Authorized Official Last Name:
LEVESQUE
Authorized Official First Name:
SONJA
Authorized Official Middle Name:
Authorized Official Title or Position:
CFO
Authorized Official Telephone Number:
801-334-1327

Provider Taxonomy Codes

  • Taxonomy code: 261QC1500X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 261QF0400X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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