1669941043 NPI number — UTAH VALLEY CLINICAL EVALUATION PHYSICIANS LC

Table of content: DR. CHARLES O'CONNOR WARD PHARMD (NPI 1891821898)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1669941043 NPI number — UTAH VALLEY CLINICAL EVALUATION PHYSICIANS LC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
UTAH VALLEY CLINICAL EVALUATION PHYSICIANS LC
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:
1669941043
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/30/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 30015
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SALT LAKE CITY
Provider Business Mailing Address State Name:
UT
Provider Business Mailing Address Postal Code:
84130-0015
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
877-346-2211
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1034 N 500 W
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
PROVO
Provider Business Practice Location Address State Name:
UT
Provider Business Practice Location Address Postal Code:
84604-3380
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
801-362-4119
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
11/15/2018

Additional Information

Authorized Official

Authorized Official Last Name:
ARMSTRONG
Authorized Official First Name:
KEN
Authorized Official Middle Name:
Authorized Official Title or Position:
PRACTICE MANAGER
Authorized Official Telephone Number:
877-346-2211

Provider Taxonomy Codes

  • Taxonomy code: 261QM2500X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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