1730768557 NPI number — BRIAN SCOTT, LLC

Table of content: (NPI 1730768557)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1730768557 NPI number — BRIAN SCOTT, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
BRIAN SCOTT, LLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
6
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1730768557
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/28/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1838 N 1075 W # 100
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
FARMINGTON
Provider Business Mailing Address State Name:
UT
Provider Business Mailing Address Postal Code:
84025-2980
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
801-923-1011
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1838 N 1075 W # 100
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
FARMINGTON
Provider Business Practice Location Address State Name:
UT
Provider Business Practice Location Address Postal Code:
84025-2980
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
801-923-1011
Provider Business Practice Location Address Fax Number:
801-923-1022
Provider Enumeration Date:
04/07/2021

Additional Information

Authorized Official

Authorized Official Last Name:
BIRD
Authorized Official First Name:
SHANNON
Authorized Official Middle Name:
Authorized Official Title or Position:
OFFICE MANAGER
Authorized Official Telephone Number:
801-923-1011

Provider Taxonomy Codes

  • Taxonomy code: 1223P0300X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 1223X0400X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 272251 . This is a "LICENSE" identifier . This identifiers is of the category "OTHER".




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