Active NPI
Paul Wiederhold
- Foster Care Agency
- Spanish Fork, UT
National Provider Identifier
1245651348
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Foster Care Agency
- License
- 19734
- Practice address
- 704 N State Road 51
Spanish Fork, UT 84660-1385 - Phone
- (801) 794-0318
- NPI assigned
- Dec 17, 2013
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Foster Care Agency | 253J00000X | 19734 | UT | Primary |
Addresses
Primary practice location
704 N State Road 51
Spanish Fork, UT 84660-1385
Mailing address
704 N State Road 51
Spanish Fork, UT 84660-1385
Phone (801) 794-0318
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 19734 | UT | MD | Foster Care Agency |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1387238400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1387238400000",
"number": "1245651348",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "704 N STATE ROAD 51",
"city": "SPANISH FORK",
"state": "UT",
"postal_code": "846601385",
"telephone_number": "801-794-0318"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "704 N STATE ROAD 51",
"city": "SPANISH FORK",
"state": "UT",
"postal_code": "846601385",
"telephone_number": "801-794-0318"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WIEDERHOLD",
"first_name": "PAUL",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2013-12-17",
"last_updated": "2013-12-17",
"status": "A"
},
"taxonomies": [
{
"code": "253J00000X",
"taxonomy_group": "",
"desc": "Foster Care Agency",
"state": "UT",
"license": "19734",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Spanish Fork, UT
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 17, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.