1710085261 NPI number — DR. THOMAS R AUSTAD DPM

Table of content: DR. THOMAS R AUSTAD DPM (NPI 1710085261)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1710085261 NPI number — DR. THOMAS R AUSTAD DPM

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
AUSTAD
Provider First Name:
THOMAS
Provider Middle Name:
R
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
DPM
Provider Gender Code:
M

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:
1710085261
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
02/08/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1885 WEST 4400 SOUTH
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ROY
Provider Business Mailing Address State Name:
UT
Provider Business Mailing Address Postal Code:
84067
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
801-731-3833
Provider Business Mailing Address Fax Number:
801-731-4561

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1885 WEST 4400 SOUTH
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ROY
Provider Business Practice Location Address State Name:
UT
Provider Business Practice Location Address Postal Code:
84067
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
801-731-3833
Provider Business Practice Location Address Fax Number:
801-731-4561
Provider Enumeration Date:
09/20/2006

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: 213E00000X , with the licence number:  1026230501 , 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: 870341157 . This is a "TAX ID" identifier . This identifiers is of the category "OTHER".
  • Identifier: 756480226 . This is a "RR MEDICARE" identifier . This identifiers is of the category "OTHER".




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