Basic Information
| Provider Information | |||||||||
| NPI: | 1780908152 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | NORTH VALLEY ANESTHESIA, LC | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 3810 | ||||||||
| Address2: | |||||||||
| City: | SALT LAKE CITY | ||||||||
| State: | UT | ||||||||
| PostalCode: | 841103810 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8014322600 | ||||||||
| FaxNumber: | 8014322668 | ||||||||
| Practice Location | |||||||||
| Address1: | 10150 CENTENNIAL PKWY | ||||||||
| Address2: | SUITE 230 | ||||||||
| City: | SANDY | ||||||||
| State: | UT | ||||||||
| PostalCode: | 840704103 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8014322600 | ||||||||
| FaxNumber: | 8014322668 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/15/2010 | ||||||||
| LastUpdateDate: | 03/15/2010 | ||||||||
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| AuthorizedOfficialLastName: | LYMAN | ||||||||
| AuthorizedOfficialFirstName: | WILLIAM | ||||||||
| AuthorizedOfficialMiddleName: | R. | ||||||||
| AuthorizedOfficialTitleorPosition: | PARTNER | ||||||||
| AuthorizedOfficialTelephone: | 8014322600 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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| AuthorizedOfficialCredential: | MD | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207L00000X | UT | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Anesthesiology |
No ID Information.