Basic Information
Provider Information | |||||||||
NPI: | 1114967163 | ||||||||
EntityType: | 1 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: |   | ||||||||
LastName: | PATTEN | ||||||||
FirstName: | CRAIG | ||||||||
MiddleName: | P | ||||||||
NamePrefix: |   | ||||||||
NameSuffix: |   | ||||||||
Credential: | MD | ||||||||
OtherOrganizationName: |   | ||||||||
OtherOrganizationType: |   | ||||||||
OtherLastName: |   | ||||||||
OtherFirstName: |   | ||||||||
OtherMiddleName: |   | ||||||||
OtherNamePrefix: |   | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: |   | ||||||||
OtherLastNameType: |   | ||||||||
Mailing Information | |||||||||
Address1: | PO BOX 10 | ||||||||
Address2: |   | ||||||||
City: | SPANISH FORK | ||||||||
State: | UT | ||||||||
PostalCode: | 846600010 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 8668987136 | ||||||||
FaxNumber: | 6169759827 | ||||||||
Practice Location | |||||||||
Address1: | 1034 NORTH 500 WEST | ||||||||
Address2: |   | ||||||||
City: | PROVO | ||||||||
State: | UT | ||||||||
PostalCode: | 84604 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 8013737850 | ||||||||
FaxNumber: |   | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 06/07/2006 | ||||||||
LastUpdateDate: | 05/06/2008 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: | M | ||||||||
AuthorizedOfficialLastName: |   | ||||||||
AuthorizedOfficialFirstName: |   | ||||||||
AuthorizedOfficialMiddleName: |   | ||||||||
AuthorizedOfficialTitleorPosition: |   | ||||||||
AuthorizedOfficialTelephone: |   | ||||||||
IsSoleProprietor: | N | ||||||||
IsOrganizationSubpart: |   | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: |   | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: |   | ||||||||
NPICertificationDate: |   |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207PE0004X | 2785521205 | UT | Y |   | Allopathic & Osteopathic Physicians | Emergency Medicine | Emergency Medical Services |
ID Information
ID | Type | State | Issuer | Description | 930085777 | 01 |   | RAILROAD MEDICARE | OTHER | P00395947 | 01 |   | RR MEDICARE | OTHER | 107005683103 | 01 | UT | SELECT HEALTH | OTHER | D3067 | 05 | UT |   | MEDICAID | 94278552104001 | 01 | UT | BCBS | OTHER | 94278552105001 | 01 | UT | BCBS | OTHER | 94278552100001 | 01 | UT | BCBS | OTHER | 870492357PA1 | 01 | UT | EDUCATORS MUTUAL | OTHER | 870636000PAT | 01 | UT | EDUCATORS MUTUAL | OTHER |