1720048887 NPI number — CHRISTINE ANDEREGG MD

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1720048887 NPI number — CHRISTINE ANDEREGG MD

Employer Identification Number (EIN):

Provider Organization Name:

Provider Last Name:

ANDEREGG

Provider First Name:

CHRISTINE

Provider Middle Name:

Provider Name Prefix Text:

Provider Name Suffix Text:

Provider Credential Text:

MD

Provider Gender Code:

F

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:

1720048887

Entity Type Code:

Individual

Replacement NPI:

Last Update Date:

04/21/2010

NPI Deactivation Reason Code:

NPI Deactivation Date:

NPI Reactivation Date:

Provider First Line Business Mailing Address:

144 S 500 E

Provider Second Line Business Mailing Address:

2ND FLOOR

Provider Business Mailing Address City Name:

SALT LAKE CITY

Provider Business Mailing Address State Name:

UT

Provider Business Mailing Address Postal Code:

84102-1907

Provider Business Mailing Address Country Code:

US

Provider Business Mailing Address Telephone Number:

Provider Business Mailing Address Fax Number:

Provider First Line Business Practice Location Address:

5475 S 500 E

Provider Second Line Business Practice Location Address:

Provider Business Practice Location Address City Name:

OGDEN

Provider Business Practice Location Address State Name:

UT

Provider Business Practice Location Address Postal Code:

84405-6905

Provider Business Practice Location Address Country Code:

US

Provider Business Practice Location Address Telephone Number:

801-479-2111

Provider Business Practice Location Address Fax Number:

Provider Enumeration Date:

03/24/2006

Authorized Official Last Name:

Authorized Official First Name:

Authorized Official Middle Name:

Authorized Official Title or Position:

Authorized Official Telephone Number:

• Taxonomy code: 207PE0004X , with the licence number:  5856641-1205 , registered in the state of UT ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
• Taxonomy code: 207P00000X , with the licence number: 5856641-1205 , registered in the state of UT ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

• Identifier: 58566411203001 . This is a "BC/BS" identifier , issued by the state of ( UT ) . This identifiers is of the category "OTHER".
• Identifier: 58566411206001 . This is a "BC/BS" identifier , issued by the state of ( UT ) . This identifiers is of the category "OTHER".
• Identifier: 58566411201001 . This is a "BC/BS" identifier , issued by the state of ( UT ) . This identifiers is of the category "OTHER".
• Identifier: 58566411204001 . This is a "BC/BS" identifier , issued by the state of ( UT ) . This identifiers is of the category "OTHER".
• Identifier: D6281 , issued by the state of ( UT ) . This identifiers is of the category "MEDICAID".
• Identifier: 58566411200001 . This is a "BC/BS" identifier , issued by the state of ( UT ) . This identifiers is of the category "OTHER".
• Identifier: 58566411202001 . This is a "BC/BS" identifier , issued by the state of ( UT ) . This identifiers is of the category "OTHER".
• Identifier: P00235569 . This is a "RAILROAD" identifier , issued by the state of ( UT ) . This identifiers is of the category "OTHER".
• Identifier: 58566411205001 . This is a "BC/BS" identifier , issued by the state of ( UT ) . This identifiers is of the category "OTHER".