Syracuse Family & Occupational Medicine PLLC

Primary specialty

Primary Care Clinic/CenterTaxonomy code 261QP2300X

License

7994885-0162 Issued in UT

Legal business name

SYRACUSE FAMILY & OCCUPATIONAL MEDICINE PLLC

Practice address

1842 S 2000 W # 2
Syracuse, UT 84075-9626

Phone

(801) 774-7450

Fax

(801) 774-7452

NPI assigned

Jul 1, 2011

Organization subpart

No

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

Authorized official

Name

Mr. Donald R Hastie, FNP--BC

Title

Owner / Operator

Phone

(801) 564-7091

Specialties & licenses 1

Addresses

Other identifiers 2

Locations

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

{
    "created_epoch": "1309478400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1309478400000",
    "number": "1639466352",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1842 S 2000 W #2",
            "city": "SYRACUSE",
            "state": "UT",
            "postal_code": "840759626",
            "telephone_number": "801-774-7450",
            "fax_number": "801-774-7452"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1842 S 2000 W # 2",
            "city": "SYRACUSE",
            "state": "UT",
            "postal_code": "840759626",
            "telephone_number": "801-774-7450",
            "fax_number": "801-774-7452"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SYRACUSE FAMILY & OCCUPATIONAL MEDICINE PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2011-07-01",
        "last_updated": "2011-07-01",
        "status": "A",
        "authorized_official_last_name": "HASTIE",
        "authorized_official_first_name": "DONALD",
        "authorized_official_middle_name": "R",
        "authorized_official_title_or_position": "OWNER / OPERATOR",
        "authorized_official_telephone_number": "801-564-7091",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "FNP--BC"
    },
    "taxonomies": [
        {
            "code": "261QP2300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Primary Care",
            "state": "UT",
            "license": "7994885-0162",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "UT LICENSE",
            "identifier": "204722-4405",
            "state": "UT"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "APRN NPI NUMBER",
            "identifier": "1619900339",
            "state": "UT"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Primary Care Clinic/Center in Syracuse, UT
• Providers in Syracuse, UT by specialty
• Primary Care Clinic/Center in Utah

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 1, 2011; 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.