1649481151 NPI number — KATHLEEN K BOYNTON MD PC

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 1649481151 NPI number — KATHLEEN K BOYNTON MD PC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
KATHLEEN K BOYNTON 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:
1649481151
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
11/25/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3584 W. 9000 S.
Provider Second Line Business Mailing Address:
300
Provider Business Mailing Address City Name:
WEST JORDAN
Provider Business Mailing Address State Name:
UT
Provider Business Mailing Address Postal Code:
84088
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
801-563-5121
Provider Business Mailing Address Fax Number:
801-565-3663

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3584 W. 9000 S.
Provider Second Line Business Practice Location Address:
300
Provider Business Practice Location Address City Name:
WEST JORDAN
Provider Business Practice Location Address State Name:
UT
Provider Business Practice Location Address Postal Code:
84088
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
801-563-5121
Provider Business Practice Location Address Fax Number:
801-565-3663
Provider Enumeration Date:
05/25/2007

Additional Information

Authorized Official

Authorized Official Last Name:
BOYNTON
Authorized Official First Name:
KATHLEEN
Authorized Official Middle Name:
KARN
Authorized Official Title or Position:
PHYSICIAN
Authorized Official Telephone Number:
801-563-5121

Provider Taxonomy Codes

  • Taxonomy code: 174400000X , with the licence number:  178452-1205 , 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: 264251147092 , issued by the state of ( UT ) . This identifiers is of the category "MEDICAID".




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