Provas of Salt Lake, LLC

Primary specialty

Vascular & Interventional Radiology PhysicianTaxonomy code 2085R0204X

Legal business name

PROVAS OF SALT LAKE, LLC

Practice address

909 E 9400 S
Sandy, UT 84094-5514

Phone

(801) 386-4240

NPI assigned

Apr 26, 2019

Organization subpart

No

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

Authorized official

Name

John Hewett, M.D.

Title

Medical Director

Phone

(801) 386-4240

Specialties & licenses 1

Addresses

Locations

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

{
    "created_epoch": "1556236800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1556236800000",
    "number": "1407410244",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "909 E 9400 S",
            "city": "SANDY",
            "state": "UT",
            "postal_code": "840945514",
            "telephone_number": "801-386-4240"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "909 E 9400 S",
            "city": "SANDY",
            "state": "UT",
            "postal_code": "840945514",
            "telephone_number": "801-386-4240"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PROVAS OF SALT LAKE, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2019-04-26",
        "last_updated": "2019-04-26",
        "status": "A",
        "authorized_official_last_name": "HEWETT",
        "authorized_official_first_name": "JOHN",
        "authorized_official_title_or_position": "MEDICAL DIRECTOR",
        "authorized_official_telephone_number": "801-386-4240",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "2085R0204X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Radiology, Vascular & Interventional Radiology",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 26, 2019; 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.