NPIMap

Organization Active NPI

Edward G. Southwick, M.D., P.C.

  • Specialist
  • West Valley City, UT
National Provider Identifier
1215287503
Registry record updated Sep 13, 2012
On this page

Key facts

NPPES NPI Registry
Primary specialty
SpecialistTaxonomy code 174400000X
Legal business name
EDWARD G. SOUTHWICK, M.D., P.C.
Practice address
3465 S 4155 W
Suite 1
West Valley City, UT 84120-2076
Phone
(801) 966-1403
Fax
(801) 964-6478
NPI assigned
Sep 13, 2012
Last updated
Sep 13, 2012By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Sep 13, 2012

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

Authorized official

Name
Dr. Edward Glen Southwick, M.D.NPI 1619957156
Title
President
Phone
(801) 966-1403

Authorized official NPPES reports the official by name only. The link goes to the one practitioner with that name whose NPPES practice address or phone number is this organization’s.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Specialist 174400000X NU Primary

Addresses

Primary practice location

3465 S 4155 W
Suite 1
West Valley City, UT 84120-2076

Mailing address

3465 S 4155 W
Suite 1
West Valley City, UT 84120-2076
Phone (801) 966-1403

Other identifiers 1

IdentifierTypeStateIssuer
071157009OtherUTRAILROAD MEDICARE

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1347494400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1347494400000",
    "number": "1215287503",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3465 S 4155 W",
            "address_2": "SUITE 1",
            "city": "WEST VALLEY CITY",
            "state": "UT",
            "postal_code": "841202076",
            "telephone_number": "801-966-1403",
            "fax_number": "801-964-6478"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3465 S 4155 W",
            "address_2": "SUITE 1",
            "city": "WEST VALLEY CITY",
            "state": "UT",
            "postal_code": "841202076",
            "telephone_number": "801-966-1403",
            "fax_number": "801-964-6478"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "EDWARD G. SOUTHWICK, M.D., P.C.",
        "organizational_subpart": "NO",
        "enumeration_date": "2012-09-13",
        "last_updated": "2012-09-13",
        "status": "A",
        "authorized_official_last_name": "SOUTHWICK",
        "authorized_official_first_name": "EDWARD",
        "authorized_official_middle_name": "GLEN",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "801-966-1403",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "174400000X",
            "taxonomy_group": "",
            "desc": "Specialist",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAILROAD MEDICARE",
            "identifier": "071157009",
            "state": "UT"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in West Valley City, UT

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 13, 2012; 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.