Basic Information
| Provider Information | |||||||||
| NPI: | 1366559791 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | AFTER HOURS MEDICAL COMPANY | ||||||||
| LastName: | |||||||||
| FirstName: | |||||||||
| MiddleName: | |||||||||
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| OtherOrganizationName: | AFTER HOURS MEDICAL - SANDY CLINIC | ||||||||
| OtherOrganizationType: | 3 | ||||||||
| OtherLastName: | |||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 1000 | ||||||||
| Address2: | |||||||||
| City: | DRAPER | ||||||||
| State: | UT | ||||||||
| PostalCode: | 840201000 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8012611919 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 7998 SOUTH 1300 EAST | ||||||||
| Address2: | |||||||||
| City: | SANDY | ||||||||
| State: | UT | ||||||||
| PostalCode: | 840940744 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8012552000 | ||||||||
| FaxNumber: | 8013527185 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/23/2006 | ||||||||
| LastUpdateDate: | 10/09/2008 | ||||||||
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| ProviderGenderCode: | |||||||||
| AuthorizedOfficialLastName: | VACHAROTHONE | ||||||||
| AuthorizedOfficialFirstName: | RACHOT | ||||||||
| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | OWNER / CEO | ||||||||
| AuthorizedOfficialTelephone: | 8012611919 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | MD | ||||||||
| NPICertificationDate: | |||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | Y | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Internal Medicine |
ID Information
| ID | Type | State | Issuer | Description | 1437251279 | 05 | UT | MEDICAID |