NPIMap

Organization Active NPI

South Payson Medical Clinic

  • Clinic/Center
  • Payson, UT
National Provider Identifier
1255691929
Registry record updated Jun 22, 2012
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinic/CenterTaxonomy code 261Q00000X
License
2785828-1206 Issued in UT
Legal business name
SOUTH PAYSON MEDICAL CLINIC
Doing business as
South Payson Clinic
Practice address
828 S 1040 W
Payson, UT 84651-4614
Phone
(940) 634-1977
NPI assigned
May 29, 2012
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 22, 2012

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

Authorized official

Name
Mr. Brent Meredith, PA-C
Title
Owner
Phone
(940) 634-1977

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Clinic/Center 261Q00000X 2785828-1206 UT Primary

Addresses

Primary practice location

828 S 1040 W
Payson, UT 84651-4614

Mailing address

828 S 1040 W
Payson, UT 84651-4614
Phone (940) 634-1977

Other names 1

  • South Payson Clinic Doing business as

National Provider Directory

National Provider Directory

NPI Registry JSON

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

{
    "created_epoch": "1338249600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1340323200000",
    "number": "1255691929",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "828 S 1040 W",
            "city": "PAYSON",
            "state": "UT",
            "postal_code": "846514614",
            "telephone_number": "940-634-1977"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "828 S 1040 W",
            "city": "PAYSON",
            "state": "UT",
            "postal_code": "846514614",
            "telephone_number": "940-634-1977"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SOUTH PAYSON MEDICAL CLINIC",
        "organizational_subpart": "NO",
        "enumeration_date": "2012-05-29",
        "last_updated": "2012-06-22",
        "status": "A",
        "authorized_official_last_name": "MEREDITH",
        "authorized_official_first_name": "BRENT",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "940-634-1977",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "PA-C"
    },
    "taxonomies": [
        {
            "code": "261Q00000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center",
            "state": "UT",
            "license": "2785828-1206",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "South Payson Clinic",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Payson, UT

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 22, 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.