1902087885 NPI number — DR BRIAN RICHMAN PC

Table of content: (NPI 1902087885)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1902087885 NPI number — DR BRIAN RICHMAN PC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
DR BRIAN RICHMAN 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:
1902087885
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/20/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1660 W ANTELOPE DR STE 110
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:
84041-1155
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
801-825-4703
Provider Business Mailing Address Fax Number:
801-774-0735

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1660 W ANTELOPE DR STE 110
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:
84041-1155
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
801-825-4703
Provider Business Practice Location Address Fax Number:
801-774-0735
Provider Enumeration Date:
11/19/2007

Additional Information

Authorized Official

Authorized Official Last Name:
RICHMAN
Authorized Official First Name:
BRIAN
Authorized Official Middle Name:
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
801-825-4709

Provider Taxonomy Codes

  • Taxonomy code: 213ES0103X , with the licence number:  106650-0501 , 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: 234764 . This is a "DESERET MUTUAL" identifier , issued by the state of ( UT ) . This identifiers is of the category "OTHER".
  • Identifier: 522988353001 . This is a "BLUECROSS BLUE SHIELD" identifier , issued by the state of ( UT ) . This identifiers is of the category "OTHER".
  • Identifier: 522988354001 . This is a "BLUECROSS BLUESHIELD" identifier , issued by the state of ( UT ) . This identifiers is of the category "OTHER".
  • Identifier: 107007424101 . This is a "SELECT HEALTH" identifier , issued by the state of ( UT ) . This identifiers is of the category "OTHER".
  • Identifier: 0000200881 . This is a "ALTIUS" identifier , issued by the state of ( UT ) . This identifiers is of the category "OTHER".
  • Identifier: 0000200882 . This is a "ALTIUS" identifier , issued by the state of ( UT ) . This identifiers is of the category "OTHER".
  • Identifier: 522988353021 , issued by the state of ( UT ) . This identifiers is of the category "MEDICAID".




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