1699010769 NPI number — JOANNE SUMPIO HINSON MD PLLC

Table of content: (NPI 1699010769)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1699010769 NPI number — JOANNE SUMPIO HINSON MD PLLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
JOANNE SUMPIO HINSON MD PLLC
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:
1699010769
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/08/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
24 S 1100 E
Provider Second Line Business Mailing Address:
STE 210
Provider Business Mailing Address City Name:
SALT LAKE CITY
Provider Business Mailing Address State Name:
UT
Provider Business Mailing Address Postal Code:
84102-1500
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
801-364-4030
Provider Business Mailing Address Fax Number:
801-364-4208

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
24 S 1100 E
Provider Second Line Business Practice Location Address:
STE 210
Provider Business Practice Location Address City Name:
SALT LAKE CITY
Provider Business Practice Location Address State Name:
UT
Provider Business Practice Location Address Postal Code:
84102-1500
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
801-364-4030
Provider Business Practice Location Address Fax Number:
801-364-4208
Provider Enumeration Date:
11/30/2012

Additional Information

Authorized Official

Authorized Official Last Name:
HINSON
Authorized Official First Name:
JOANNE
Authorized Official Middle Name:
SUMPIO
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
801-364-4030

Provider Taxonomy Codes

  • Taxonomy code: 207VG0400X , with the licence number:  2756871205 , 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: 10021959 . This is a "OWNERS DOB" identifier . This identifiers is of the category "OTHER".




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