1629230958 NPI number — MOUNTAIN WEST CARDIOVASCULAR ASSOCIATES

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1629230958 NPI number — MOUNTAIN WEST CARDIOVASCULAR ASSOCIATES

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
MOUNTAIN WEST CARDIOVASCULAR ASSOCIATES
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:
1629230958
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
06/23/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
5169 COTTONWOOD ST
Provider Second Line Business Mailing Address:
SUITE B620
Provider Business Mailing Address City Name:
MURRAY
Provider Business Mailing Address State Name:
UT
Provider Business Mailing Address Postal Code:
84107-6767
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
801-507-8600
Provider Business Mailing Address Fax Number:
801-507-8602

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
5169 COTTONWOOD ST
Provider Second Line Business Practice Location Address:
SUITE B620
Provider Business Practice Location Address City Name:
MURRAY
Provider Business Practice Location Address State Name:
UT
Provider Business Practice Location Address Postal Code:
84158
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
801-507-8600
Provider Business Practice Location Address Fax Number:
801-507-8602
Provider Enumeration Date:
06/27/2008

Additional Information

Authorized Official

Authorized Official Last Name:
WARDLE
Authorized Official First Name:
TERI
Authorized Official Middle Name:
J
Authorized Official Title or Position:
CREDENTIALING COORDINATOR
Authorized Official Telephone Number:
801-676-3723

Provider Taxonomy Codes

  • Taxonomy code: 174400000X , 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)





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