1629475967 NPI number — AUGUST CAPRI QUAIFE MOTR/L, LMT

Table of content: AUGUST CAPRI QUAIFE MOTR/L, LMT (NPI 1629475967)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1629475967 NPI number — AUGUST CAPRI QUAIFE MOTR/L, LMT

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
QUAIFE
Provider First Name:
AUGUST
Provider Middle Name:
CAPRI
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MOTR/L, LMT
Provider Gender Code:
F

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:
1629475967
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
01/23/2019
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 363
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
RIVERTON
Provider Business Mailing Address State Name:
UT
Provider Business Mailing Address Postal Code:
84065-0363
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
800-472-9515
Provider Business Mailing Address Fax Number:
801-447-0107

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
12453 S 265 W STE B
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
DRAPER
Provider Business Practice Location Address State Name:
UT
Provider Business Practice Location Address Postal Code:
84020-5420
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
801-443-7775
Provider Business Practice Location Address Fax Number:
801-447-0107
Provider Enumeration Date:
12/02/2014

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: 225700000X , with the licence number:  5044485-4701 , registered in the state of UT ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 225X00000X , with the licence number: 5044485-4201 , 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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