MARVON SHANE HOLDAWAY CM NPI 1053045898

NPI Information

NPI: 1053045898
Provider Name: MARVON SHANE HOLDAWAY, CM
Classification: Clinic/Center - 261QR0405X
Entity Type: Individual

Specialization: Rehabilitation, Substance Use Disorder

Address:
265 N STATE ST
MOUNT PLEASANT, UT
ZIP 84647
Phone: (435) 462-2781
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Marvon Shane Holdaway, CM is a rehabilitation and substance use disorder clinic center in Mount Pleasant, UT. Marvon Shane Holdaway, CM NPI is 1053045898. The provider is registered as an individual entity type.

The NPPES NPI record indicates the provider is a male.

The provider's business location address is:

265 N STATE ST
MOUNT PLEASANT, UT
ZIP 84647-108
Phone: (435) 462-2781
Fax: (435) 462-0155

The enumeration date for this NPI number is 7/15/2022 and was last updated on 7/18/2022.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. 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	261QR0405X	Clinic/Center	Rehabilitation, Substance Use Disorder			Yes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No.	Other Provider Identifier	Other Provider Identifier Type	Other Provider Identifier State	Other Provider Identifier Issuer
1	HT007021-001	MEDICAID	UTAH

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 4/28/2024

NPI Synchronization or Removal

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