PIONEER VALLEY HOSPITAL PHYSICIANS, INC (INTERNAL MEDICINE SPECIALISTS) - NPI NUMBER 1396782124

Summary

Provider Name: PIONEER VALLEY HOSPITAL PHYSICIANS, INC (INTERNAL MEDICINE SPECIALISTS)

NPI Number: 1396782124

Clasification: Internal Medicine (207R00000X)

Address:
2530 W 4700 S
SUITE B8
SALT LAKE CITY, UT
ZIP 84118

Phone Number: (801) 967-5866



Detailed Information

PIONEER VALLEY HOSPITAL PHYSICIANS, INC is an internist in Salt Lake City, UT. The provider is a physician who provides long-term, comprehensive care in the office and the hospital, managing both common and complex illness of adolescents, adults and the elderly. Internists are trained in the diagnosis and treatment of cancer, infections and diseases affecting the heart, blood, kidneys, joints and digestive, respiratory and vascular systems. They are also trained in the essentials of primary care internal medicine, which incorporates an understanding of disease prevention, wellness, substance abuse, mental health and effective treatment of common problems of the eyes, ears, skin, nervous system and reproductive organs. The assigned NPI number for this provider is 1396782124 and is registered as an organization entity type and is a single specialty group.
The provider Is Doing Business As Internal Medicine Specialists.

The provider's business address is:

2530 W 4700 S
SUITE B8
SALT LAKE CITY, UT
ZIP 84118-865
Phone: (801) 967-5866
Fax: (801) 969-9037

The provider's authorized official is Mandi J Mckay .
The authorized official title is Ceo and has the following contact phone number (801) 967-5866.

The enumeration date for this NPI number is 6/1/2006 and was last updated on 7/8/2007.

Map - Location of Practice

Taxonomy Codes

The following information regarding the scope of practice of this provider is available:

No. Taxonomy Code Taxonomy Clasification Taxonomy Specialization License Number License State Primary
1 207R00000X Internal Medicine Yes

NPI Record

No. Field Name Field Value Field Definition 1
1 NPI 1396782124 The 10-position all-numeric identification number assigned by the NPS to uniquely identify a health care provider. The NPI number includes an ISO standard check-digit in the 10th position. There is no intelligence about the health care provider in the number.
2 Entity Type Code 2 Code describing the type of health care provider that is being assigned an NPI. Codes are 1 = (Person): individual human being who furnishes health care; 2 = (Non-person): entity other than an individual human being that furnishes health care (for example, hospital, SNF, hospital subunit, pharmacy, or HMO).
3 Employer Identification Number EIN The Employer Identification Number (EIN), assigned by the IRS, of the provider being identified.
4 Provider Organization Name Legal Business Name PIONEER VALLEY HOSPITAL PHYSICIANS, INC The name of the organization provider. If the provider is an organization, this is the legal business name.
5 Provider Other Organization Name INTERNAL MEDICINE SPECIALISTS Other name by which the organization provider is or has been known.
6 Provider Other Organization Name Type Code 3 Code identifying the type of other name. Codes are: 1 = former name; 2 = professional name; 3 = doing business as (d/b/ a) name; 4 = former legal business name; 5 = other.
7 Provider First Line Business Practice Location Address 2530 W 4700 S The first line location address of the provider being identified. For providers with more than one physical location, this is the primary location. This address cannot include a Post Office box.
8 Provider Second Line Business Practice Location Address SUITE B8 The second line location address of the provider being identified. For providers with more than one physical location, this is the primary location. This address cannot include a Post Office box.
9 Provider Business Practice Location Address City Name SALT LAKE CITY The city name in the location address of the provider being identified.
10 Provider Business Practice Location Address State Name UT The State code in the location of the provider being identified.
11 Provider Business Practice Location Address Postal Code 841181865 The postal ZIP or zone code in the location address of the provider being identified. NOTE: ZIP code plus 4-digit extension, if available.
12 Provider Business Practice Location Address Country Code If outside U S US The country code in the location address of the provider being identified.
13 Provider Business Practice Location Address Telephone Number 8019675866 The telephone number associated with the location address of the provider being identified.
14 Provider Business Practice Location Address Fax Number 8019699037 The fax number associated with the location address of the provider being identified.
15 Provider Enumeration Date 6/1/2006 The date the provider was assigned a unique identifier (assigned an NPI).
16 Last Update Date 7/8/2007 The date that a record was last updated or changed.
17 Authorized Official Last Name MCKAY The last name of the person authorized to submit the NPI application or to change NPS data for a health care provider.
18 Authorized Official First Name MANDI The first name of the authorized official.
19 Authorized Official Middle Name J The middle name of the authorized official.
20 Authorized Official Title or Position CEO The title or position of the authorized official.
21 Authorized Official Telephone Number 8019675866 The 10-position telephone number of the authorized official.
22 Healthcare Provider Taxonomy Code 1 207R00000X Code designating the provider type, classification, and specialization. Codes are from the Healthcare Provider Taxonomy code list. The NPS will associate these data with the license data for providers with Entity type code = 1.
23 Healthcare Provider Primary Taxonomy Switch 1 Y
24 Authorized Official Credential Text MD
25 Healthcare Provider Taxonomy Group 1 193400000X SINGLE SPECIALTY GROUP

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This page was last updated on: 4/19/2015

(1) Field Definition Source-. Federal Register / Vol. 69, No. 15 / Friday, January 23, 2004 / Rules and Regulations - Part II Department of Health and Human Services Office of the Secretary 45 CFR Part 162 HIPAA Administrative Simplification: Standard Unique Health Identifier for Health Care Providers; Final Rule

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