Basic Information
| Provider Information | |||||||||
| NPI: | 1629303169 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | SILVERTON GROUP LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 1249 | ||||||||
| Address2: | |||||||||
| City: | BOUNTIFUL | ||||||||
| State: | UT | ||||||||
| PostalCode: | 840111249 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8012962113 | ||||||||
| FaxNumber: | 8012961715 | ||||||||
| Practice Location | |||||||||
| Address1: | 4252 S BIRKHILL BLVD | ||||||||
| Address2: | |||||||||
| City: | MURRAY | ||||||||
| State: | UT | ||||||||
| PostalCode: | 841075715 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3854250050 | ||||||||
| FaxNumber: | 8019512389 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/15/2009 | ||||||||
| LastUpdateDate: | 09/19/2019 | ||||||||
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| AuthorizedOfficialLastName: | MARTINEZ | ||||||||
| AuthorizedOfficialFirstName: | MARK | ||||||||
| AuthorizedOfficialMiddleName: | L | ||||||||
| AuthorizedOfficialTitleorPosition: | MANAGING PARTNER | ||||||||
| AuthorizedOfficialTelephone: | 8013504110 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | MD | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208M00000X | Y | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Hospitalist |
ID Information
| ID | Type | State | Issuer | Description | 1629303169 | 05 | NV | MEDICAID | 1629303169 | 05 | UT | MEDICAID | 1629303169 | 05 | ID | MEDICAID |