Basic Information
| Provider Information | |||||||||
| NPI: | 1992724975 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | CENTRAL VALLEY MEDICAL CENTER | ||||||||
| LastName: | |||||||||
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| OtherOrganizationName: | NEPHI MEDICAL CLINIC | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 48 W 1500 N | ||||||||
| Address2: | PO BOX 120 | ||||||||
| City: | NEPHI | ||||||||
| State: | UT | ||||||||
| PostalCode: | 846488900 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4356233000 | ||||||||
| FaxNumber: | 4356233145 | ||||||||
| Practice Location | |||||||||
| Address1: | 48 W 1500 N | ||||||||
| Address2: | |||||||||
| City: | NEPHI | ||||||||
| State: | UT | ||||||||
| PostalCode: | 846488900 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4356233000 | ||||||||
| FaxNumber: | 4356233145 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/19/2006 | ||||||||
| LastUpdateDate: | 06/08/2017 | ||||||||
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| AuthorizedOfficialLastName: | DAVIS | ||||||||
| AuthorizedOfficialFirstName: | BRENT | ||||||||
| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | CFO | ||||||||
| AuthorizedOfficialTelephone: | 4356233000 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | Y | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Family Medicine |
No ID Information.