Providential Bba Operating LP

Primary specialty

Nurse PractitionerTaxonomy code 363L00000X

Legal business name

PROVIDENTIAL BBA OPERATING LP

Doing business as

SDCH Physician Group

Practice address

401 S 400 E
Bountiful, UT 84010-4933

Phone

(801) 397-8145

Fax

(201) 294-5877

NPI assigned

Oct 17, 2023

Last updated

Oct 17, 2023By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Michelle Brown, CFO

Title

Cfo

Phone

(801) 397-8145

Specialties & licenses 4

Addresses

Other names 1

• SDCH Physician Group Doing business as

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

{
    "created_epoch": "1697500800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1697500800000",
    "number": "1376325001",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "481 S 400 E",
            "city": "BOUNTIFUL",
            "state": "UT",
            "postal_code": "840104933",
            "telephone_number": "801-397-8145",
            "fax_number": "801-294-5877"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "401 S 400 E",
            "city": "BOUNTIFUL",
            "state": "UT",
            "postal_code": "840104933",
            "telephone_number": "801-397-8145",
            "fax_number": "201-294-5877"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PROVIDENTIAL BBA OPERATING LP",
        "organizational_subpart": "NO",
        "enumeration_date": "2023-10-17",
        "last_updated": "2023-10-17",
        "certification_date": "2023-10-16",
        "status": "A",
        "authorized_official_last_name": "BROWN",
        "authorized_official_first_name": "MICHELLE",
        "authorized_official_title_or_position": "CFO",
        "authorized_official_telephone_number": "801-397-8145",
        "authorized_official_credential": "CFO"
    },
    "taxonomies": [
        {
            "code": "207RE0101X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Internal Medicine, Endocrinology, Diabetes & Metabolism",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207RH0002X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Internal Medicine, Hospice and Palliative Medicine",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207RP1001X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Internal Medicine, Pulmonary Disease",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "363L00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Nurse Practitioner",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "SDCH Physician Group",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• Nurse Practitioner in Bountiful, UT
• Providers in Bountiful, UT by specialty
• Nurse Practitioner in Utah

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 17, 2023; 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.