Basic Information
| Provider Information | |||||||||
| NPI: | 1548303795 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | CACHE VALLEY EAR NOSE & THROAT, PLLC | ||||||||
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| OtherOrganizationName: | CACHE VALLEY EAR NOSE AND THROAT. | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2245 N 400 E STE 301 | ||||||||
| Address2: | |||||||||
| City: | NORTH LOGAN | ||||||||
| State: | UT | ||||||||
| PostalCode: | 843411892 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4357537880 | ||||||||
| FaxNumber: | 4353594507 | ||||||||
| Practice Location | |||||||||
| Address1: | 2245 N 400 E | ||||||||
| Address2: | STE 301 | ||||||||
| City: | NORTH LOGAN | ||||||||
| State: | UT | ||||||||
| PostalCode: | 843411892 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4357537880 | ||||||||
| FaxNumber: | 4353594507 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/15/2007 | ||||||||
| LastUpdateDate: | 06/24/2022 | ||||||||
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| AuthorizedOfficialLastName: | THALMAN | ||||||||
| AuthorizedOfficialFirstName: | LINSEY | ||||||||
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| AuthorizedOfficialTitleorPosition: | BILLING SPECIALIST | ||||||||
| AuthorizedOfficialTelephone: | 4357537880 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| NPICertificationDate: | 06/18/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207YX0007X | C97276 | UT | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Otolaryngology | Plastic Surgery within the Head & Neck |
ID Information
| ID | Type | State | Issuer | Description | 805387100 | 05 | ID | MEDICAID | 118280300 | 05 | WY | MEDICAID | 1548303795 | 05 | UT | MEDICAID | 87037196400 | 05 | UT | MEDICAID |