1700182961 NPI number — LEGACY HEALTHCARE OF LAYTON, LLC

Table of content: ELIZA TOWNSEND FIRN MD (NPI 1235634106)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1700182961 NPI number — LEGACY HEALTHCARE OF LAYTON, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
LEGACY HEALTHCARE OF LAYTON, LLC
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:
1700182961
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
02/07/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1203 N FAIRFIELD RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LAYTON
Provider Business Mailing Address State Name:
UT
Provider Business Mailing Address Postal Code:
84041-8321
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
801-807-0113
Provider Business Mailing Address Fax Number:
801-927-6235

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1203 N FAIRFIELD RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LAYTON
Provider Business Practice Location Address State Name:
UT
Provider Business Practice Location Address Postal Code:
84041-8321
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
801-807-0113
Provider Business Practice Location Address Fax Number:
801-927-6235
Provider Enumeration Date:
02/07/2011

Additional Information

Authorized Official

Authorized Official Last Name:
MINOR
Authorized Official First Name:
JAUNICE
Authorized Official Middle Name:
Authorized Official Title or Position:
BUSINESS OFFICE MANAGER
Authorized Official Telephone Number:
801-807-0113

Provider Taxonomy Codes

  • Taxonomy code: 314000000X , with the licence number:  2010-NCF-98320 , 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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