NPIMap

Molina Healthcare of Utah Inc

Organization Active NPI Family Nurse Practitioner · Midvale, UT

NPI 1619486396 · NPPES record last updated Nov 8, 2024

Key facts

NPI
1619486396
Entity type
Organization (NPI type 2)
Primary specialty
Family Nurse Practitioner 363LF0000X
Legal business name
MOLINA HEALTHCARE OF UTAH INC
Practice address
7050 S Union Park Ave Ste 200
Midvale, UT 84047-4171
Phone
(888) 562-5442
Fax
(562) 499-6191
NPI assigned
Sep 25, 2017
Organization subpart
Yes
Parent organization (as reported)
MOLINA HEALTHCARE

Authorized official

Name
Gina Turley
Title
VP, Clinic Informatics
Phone
(888) 562-5442

Practitioners 77

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

View all 77

Medicare participation

Medicare fee-for-service enrollment
Enrolled in UT

Medicare enrollment records

Enrollment IDStateProvider typePAC IDDetails
O20171204002662 UT Part B Supplier - Clinic/Group Practice 8224395041 Receives reassigned benefits from 74 practitioners
Practice locations: Midvale, UT

National Provider Directory

Part of
Molina Healthcare

Locations

7050 S Union Park Ave
Ste 200
Midvale, UT 84047
Phone (562) 549-3966

Interoperability endpoints

  • FHIR API: https://epicproxy.et1057.epichosted.com/FHIRProxy/api/FHIR/R4/

Specialties & licenses

Specialty (taxonomy)CodeLicenseStatePrimary
Family Nurse Practitioner
Group: 193400000X SINGLE SPECIALTY GROUP		 363LF0000X Yes

Addresses

Primary practice location

7050 S Union Park Ave Ste 200
Midvale, UT 84047-4171

Mailing address

200 Oceangate Ste 100
Long Beach, CA 90802-4317
Phone (888) 562-5442

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API JSON format, last updated by the provider on Nov 8, 2024.

{
    "created_epoch": "1506297600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1731024000000",
    "number": "1619486396",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "200 OCEANGATE STE 100",
            "city": "LONG BEACH",
            "state": "CA",
            "postal_code": "908024317",
            "telephone_number": "888-562-5442",
            "fax_number": "562-499-6191"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "7050 S UNION PARK AVE STE 200",
            "city": "MIDVALE",
            "state": "UT",
            "postal_code": "840474171",
            "telephone_number": "888-562-5442",
            "fax_number": "562-499-6191"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MOLINA HEALTHCARE OF UTAH INC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "MOLINA HEALTHCARE",
        "enumeration_date": "2017-09-25",
        "last_updated": "2024-11-08",
        "certification_date": "2024-11-08",
        "status": "A",
        "authorized_official_last_name": "TURLEY",
        "authorized_official_first_name": "GINA",
        "authorized_official_title_or_position": "VP, CLINIC INFORMATICS",
        "authorized_official_telephone_number": "888-562-5442"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Nurse Practitioner, Family",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Midvale, UT

All providers in Midvale, UT · Family Nurse Practitioner in Utah

Sources for this page

Verify at the official NPI Registry.