1831267145 NPI number — MARY ANN MCDONNELL MD PC

Table of content: (NPI 1831267145)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1831267145 NPI number — MARY ANN MCDONNELL MD PC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
MARY ANN MCDONNELL MD PC
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:
1831267145
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
301 NORTH 200 EAST
Provider Second Line Business Mailing Address:
SUITE 1D
Provider Business Mailing Address City Name:
ST GEORGE
Provider Business Mailing Address State Name:
UT
Provider Business Mailing Address Postal Code:
84770
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
435-628-3636
Provider Business Mailing Address Fax Number:
435-634-9216

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
301 NORTH 200 EAST
Provider Second Line Business Practice Location Address:
SUITE 1D
Provider Business Practice Location Address City Name:
ST GEORGE
Provider Business Practice Location Address State Name:
UT
Provider Business Practice Location Address Postal Code:
84770
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
435-628-3636
Provider Business Practice Location Address Fax Number:
435-634-9216
Provider Enumeration Date:
12/04/2006

Additional Information

Authorized Official

Authorized Official Last Name:
MCDONNELL
Authorized Official First Name:
MARY ANN
Authorized Official Middle Name:
Authorized Official Title or Position:
OWNER MD PC
Authorized Official Telephone Number:
435-628-3636

Provider Taxonomy Codes

  • Taxonomy code: 207RC0000X , with the licence number:  1583921205 , 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: 516523696034 , issued by the state of ( UT ) . This identifiers is of the category "MEDICAID".




Copyright © 2007-2025 www.npivalidator.com