CENTERVILLE MEDICAL CENTER NPI 1205187325

NPI Information

NPI: 1205187325
Provider Name: CENTERVILLE MEDICAL CENTER
Classification: Clinic/Center - 261QM1300X
Specialization: Multi-Specialty
Entity Type: Organization
Doing Business As: MAPLEWOOD MEDICAL
Address: 6783 S REDWOOD RD
SUITE 104
WEST JORDAN, UT
ZIP 84084
Phone: (801) 268-2929

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NPI Details

CENTERVILLE MEDICAL CENTER is a multi-specialty clinic center in West Jordan, UT. CENTERVILLE MEDICAL CENTER NPI is 1205187325. The provider is registered as an organization entity type.
The provider Is Doing Business As Maplewood Medical.

The provider's business location address is:

6783 S REDWOOD RD
SUITE 104
WEST JORDAN, UT
ZIP 84084-677
Phone: (801) 268-2929
Fax: (801) 268-0198

The provider's authorized official is Robert E Park .
The authorized official title is Ceo and has the following contact phone number (801) 298-7330.

The enumeration date for this NPI number is 9/28/2012 and was last updated on 2/27/2014.

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	261QM1300X	Clinic/Center	Multi-Specialty		UTAH	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	000067114	MEDICARE PIN	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: 11/21/2025

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