1871838268 NPI number — MARK S. NAISBITT, MD, PC

Table of content: (NPI 1871838268)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1871838268 NPI number — MARK S. NAISBITT, MD, PC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
MARK S. NAISBITT, 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:
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:
1871838268
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
12/11/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3460 BAKER DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
OGDEN
Provider Business Mailing Address State Name:
UT
Provider Business Mailing Address Postal Code:
84403-1310
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
801-392-1401
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4401 HARRISON BLVD
Provider Second Line Business Practice Location Address:
MCKAY DEE HOSPITAL
Provider Business Practice Location Address City Name:
OGDEN
Provider Business Practice Location Address State Name:
UT
Provider Business Practice Location Address Postal Code:
84403-3195
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
801-589-2006
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
12/11/2012

Additional Information

Authorized Official

Authorized Official Last Name:
NAISBITT
Authorized Official First Name:
MARK
Authorized Official Middle Name:
S.
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
801-392-1401

Provider Taxonomy Codes

  • Taxonomy code: 207LP2900X , with the licence number:  184191-1205 , 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: 20167 . This is a "DESERET MUTUAL" identifier , issued by the state of ( UT ) . This identifiers is of the category "OTHER".
  • Identifier: 050041375 . This is a "MEDICARE ID-RAILROAD MEDICARE" identifier , issued by the state of ( UT ) . This identifiers is of the category "OTHER".
  • Identifier: 107005583101 . This is a "IHC" identifier , issued by the state of ( UT ) . This identifiers is of the category "OTHER".
  • Identifier: 2090168 . This is a "UNITED HEALTHCARE" identifier , issued by the state of ( UT ) . This identifiers is of the category "OTHER".
  • Identifier: 100501270 , issued by the state of ( NV ) . This identifiers is of the category "MEDICAID".
  • Identifier: 8597445 . This is a "WORKERS COMP" identifier , issued by the state of ( UT ) . This identifiers is of the category "OTHER".
  • Identifier: QM0000075886 . This is a "ALTIUS" identifier , issued by the state of ( UT ) . This identifiers is of the category "OTHER".
  • Identifier: 005532737 . This is a "MEDICARE ID-TYPE UNSPECIFIED" identifier , issued by the state of ( UT ) . This identifiers is of the category "OTHER".
  • Identifier: 104856200 , issued by the state of ( WY ) . This identifiers is of the category "MEDICAID".
  • Identifier: 37807 . This is a "PEHP" identifier , issued by the state of ( UT ) . This identifiers is of the category "OTHER".
  • Identifier: 1502954 . This is a "UMWA" identifier , issued by the state of ( UT ) . This identifiers is of the category "OTHER".
  • Identifier: 822107 , issued by the state of ( AZ ) . This identifiers is of the category "MEDICAID".
  • Identifier: 53257 . This is a "HEALTHY U" identifier , issued by the state of ( UT ) . This identifiers is of the category "OTHER".
  • Identifier: 804100900 , issued by the state of ( ID ) . This identifiers is of the category "MEDICAID".
  • Identifier: PRA06691 . This is a "MOLINA" identifier , issued by the state of ( UT ) . This identifiers is of the category "OTHER".
  • Identifier: 87054614NA1 . This is a "EDUCATORS MUTUAL" identifier , issued by the state of ( UT ) . This identifiers is of the category "OTHER".




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