NPIMap

Organization Active NPI

Woodmead Medical Clinic PLLC

  • Clinic/Center
  • Bountiful, UT
National Provider Identifier
1194013870
Registry record updated Jul 15, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinic/CenterTaxonomy code 261Q00000X
License
5863514-1205 Issued in UT
Legal business name
WOODMEAD MEDICAL CLINIC PLLC
Practice address
3263 S Highway 89
Suite 300
Bountiful, UT 84010-8555
Phone
(801) 296-0600
Fax
(801) 295-1700
NPI assigned
Jul 15, 2011
Last updated
Jul 15, 2011By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 15, 2011

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Dr. Gavin N Van Staden, M.D.
Title
Owner
Phone
(801) 296-0600

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Clinic/Center 261Q00000X 5863514-1205 UT Primary
Clinic/Center 261Q00000X 284903-1205 UT

Addresses

Primary practice location

3263 S Highway 89
Suite 300
Bountiful, UT 84010-8555

Mailing address

3263 S Highway 89
Suite 300
Bountiful, UT 84010-8555
Phone (801) 296-0600

National Provider Directory

National Provider Directory

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1310688000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1310688000000",
    "number": "1194013870",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3263 S HIGHWAY 89",
            "address_2": "SUITE 300",
            "city": "BOUNTIFUL",
            "state": "UT",
            "postal_code": "840108555",
            "telephone_number": "801-296-0600",
            "fax_number": "801-295-1700"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3263 S HIGHWAY 89",
            "address_2": "SUITE 300",
            "city": "BOUNTIFUL",
            "state": "UT",
            "postal_code": "840108555",
            "telephone_number": "801-296-0600",
            "fax_number": "801-295-1700"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "WOODMEAD MEDICAL CLINIC PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2011-07-15",
        "last_updated": "2011-07-15",
        "status": "A",
        "authorized_official_last_name": "VAN STADEN",
        "authorized_official_first_name": "GAVIN",
        "authorized_official_middle_name": "N",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "801-296-0600",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "261Q00000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center",
            "state": "UT",
            "license": "5863514-1205",
            "primary": true
        },
        {
            "code": "261Q00000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center",
            "state": "UT",
            "license": "284903-1205",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Bountiful, UT

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 15, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.