Active NPI
Raphael Nutakor
- Home Modifications Contractor
- Midvale, UT
National Provider Identifier
1487071973
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Home Modifications Contractor
- License
- 52162
- Practice address
- 1042 E Fort Union Blvd # 123
Midvale, UT 84047 - Phone
- (775) 287-5508
- NPI assigned
- Mar 24, 2014
- 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 |
|---|---|---|---|---|
| Home Modifications Contractor | 171WH0202X | 52162 | UT | Primary |
Addresses
Primary practice location
1042 E Fort Union Blvd # 123
Midvale, UT 84047
Mailing address
48 W Inglenook Drive #720
Midvale, UT 84047
Phone (775) 287-5508
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 |
|---|---|---|---|
| 52162 | UT | MD | Home Modifications Contractor |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Superior Care LLC | Current | Accepting new patients |
Organizations & group practices 1
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.
-
- Marriage & Family Therapist
- Sparks, NV
- NPI 1144735044
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1395619200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1395619200000",
"number": "1487071973",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "48 W INGLENOOK DRIVE #720",
"city": "MIDVALE",
"state": "UT",
"postal_code": "84047",
"telephone_number": "775-287-5508"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1042 E FORT UNION BLVD # 123",
"city": "MIDVALE",
"state": "UT",
"postal_code": "84047",
"telephone_number": "775-287-5508"
}
],
"practiceLocations": [],
"basic": {
"last_name": "NUTAKOR",
"first_name": "RAPHAEL",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2014-03-24",
"last_updated": "2014-03-24",
"status": "A"
},
"taxonomies": [
{
"code": "171WH0202X",
"taxonomy_group": "",
"desc": "Contractor, Home Modifications",
"state": "UT",
"license": "52162",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Midvale, UT
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 24, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.