1942345038 NPI number — FIRSTMED MURRAY

Table of content: (NPI 1942345038)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1942345038 NPI number — FIRSTMED MURRAY

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
FIRSTMED MURRAY
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:
FIRSTMED MURRAY URGENT CARE
Provider Other Organization Name Type Code:
3
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:
1942345038
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
06/22/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 307
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BOUNTIFUL
Provider Business Mailing Address State Name:
UT
Provider Business Mailing Address Postal Code:
84011-0307
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
801-294-6907
Provider Business Mailing Address Fax Number:
801-294-6917

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
5911 FASHION BLVD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MURRAY
Provider Business Practice Location Address State Name:
UT
Provider Business Practice Location Address Postal Code:
84107-7352
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
801-266-6483
Provider Business Practice Location Address Fax Number:
801-266-6916
Provider Enumeration Date:
02/20/2007

Additional Information

Authorized Official

Authorized Official Last Name:
KREMER
Authorized Official First Name:
DAVE
Authorized Official Middle Name:
Authorized Official Title or Position:
DIRECTOR
Authorized Official Telephone Number:
801-973-2588

Provider Taxonomy Codes

  • Taxonomy code: 261QU0200X , with the licence number:  5212615-1205 , 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)





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