1922174705 NPI number — RAY ANDREW, MD, PC

Table of content: (NPI 1922174705)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1922174705 NPI number — RAY ANDREW, MD, PC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
RAY ANDREW, 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:
1922174705
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/07/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2700 S HIGHWAY 191 STE 2
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MOAB
Provider Business Mailing Address State Name:
UT
Provider Business Mailing Address Postal Code:
84532-3443
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
435-259-4466
Provider Business Mailing Address Fax Number:
435-259-4467

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2700 S HIGHWAY 191 STE 2
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MOAB
Provider Business Practice Location Address State Name:
UT
Provider Business Practice Location Address Postal Code:
84532-3443
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
435-259-4466
Provider Business Practice Location Address Fax Number:
435-259-4467
Provider Enumeration Date:
11/25/2006

Additional Information

Authorized Official

Authorized Official Last Name:
ANDREW
Authorized Official First Name:
RAY
Authorized Official Middle Name:
ALLEN
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
435-259-4466

Provider Taxonomy Codes

  • Taxonomy code: 261QP2300X , with the licence number:  5160918-0144 , 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: 558752212-004 , issued by the state of ( UT ) . This identifiers is of the category "MEDICAID".
  • Identifier: QM0000071700 . This is a "ALTIUS PROVIDER NUMBER" identifier , issued by the state of ( UT ) . This identifiers is of the category "OTHER".
  • Identifier: 5141202-1205 . This is a "STATE LICENSE NUMBER" identifier , issued by the state of ( UT ) . This identifiers is of the category "OTHER".
  • Identifier: 107012421102 . This is a "SELECT HEALTH PROVIDER #" identifier , issued by the state of ( UT ) . This identifiers is of the category "OTHER".
  • Identifier: 755227 . This is a "DMBA PROVIDER #" identifier , issued by the state of ( UT ) . This identifiers is of the category "OTHER".
  • Identifier: 51412021201001 . This is a "BLUE CROSS BLUE SHIELD" identifier , issued by the state of ( UT ) . This identifiers is of the category "OTHER".
  • Identifier: 68474 . This is a "PEHP PROVIDER NUMBER" identifier , issued by the state of ( UT ) . This identifiers is of the category "OTHER".




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