Active NPI
Northeastern Utah Medical Group
- Physician Assistant
- Roosevelt, UT
National Provider Identifier
1316316482
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physician Assistant
- License
- 6411766-1206
- Legal business name
- NORTHEASTERN UTAH MEDICAL GROUP
- Practice address
- 250 W 300 N
Roosevelt, UT 84066-2336 - Phone
- (435) 722-4691
- Fax
- (435) 722-9291
- NPI assigned
- Sep 18, 2015
- Last updated
- Sep 18, 2015
- Organization subpart
- Yes
- Parent organization
- UINTAH BASIN MEDICAL CENTER
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Authorized official
- Name
- James I Marshal
- Title
- Ceo
- Phone
- (435) 722-6162
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physician Assistant | 363A00000X | 6411766-1206 | UT | Primary |
Addresses
Primary practice location
250 W 300 N
Roosevelt, UT 84066-2336
Mailing address
250 W 300 N
Roosevelt, UT 84066-2336
Phone (435) 722-4691
National Provider Directory
National Provider Directory- Tax ID family
- NE Utah Medical Group
- Part of
- Duchesne Co Hosp
Other organizations with this tax ID 1
Organizations that report the same tax identification number in the National Provider Directory.
-
- Durable Medical Equipment & Medical Supplies
- Roosevelt, UT
- NPI 1740482009
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.
-
- Internal Medicine Physician
- Provo, UT
- NPI 1083674972
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1442534400000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1442534400000",
"number": "1316316482",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "250 W 300 N",
"city": "ROOSEVELT",
"state": "UT",
"postal_code": "840662336",
"telephone_number": "435-722-4691",
"fax_number": "435-722-9291"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "250 W 300 N",
"city": "ROOSEVELT",
"state": "UT",
"postal_code": "840662336",
"telephone_number": "435-722-4691",
"fax_number": "435-722-9291"
}
],
"practiceLocations": [],
"basic": {
"organization_name": "NORTHEASTERN UTAH MEDICAL GROUP",
"organizational_subpart": "YES",
"parent_organization_legal_business_name": "UINTAH BASIN MEDICAL CENTER",
"enumeration_date": "2015-09-18",
"last_updated": "2015-09-18",
"status": "A",
"authorized_official_last_name": "MARSHAL",
"authorized_official_first_name": "JAMES",
"authorized_official_middle_name": "I",
"authorized_official_title_or_position": "CEO",
"authorized_official_telephone_number": "435-722-6162"
},
"taxonomies": [
{
"code": "363A00000X",
"taxonomy_group": "",
"desc": "Physician Assistant",
"state": "UT",
"license": "6411766-1206",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Roosevelt, UT
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 18, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.