NPIMap

Organization Active NPI

Medical Director Services, LLC

  • Specialist
  • Sandy, UT
National Provider Identifier
1770751323
Registry record updated Apr 17, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
SpecialistTaxonomy code 174400000X
License
5049379-1205 Issued in UT
Legal business name
MEDICAL DIRECTOR SERVICES, LLC
Practice address
50 E 9000 S
Sandy, UT 84070-2201
Phone
(801) 561-9839
NPI assigned
Feb 18, 2008
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 17, 2008

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

Authorized official

Name
Kavita G Willesen, M.D.
Title
President/Physician
Phone
(801) 809-9471

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
SpecialistGroup: 193400000X SINGLE SPECIALTY GROUP 174400000X 5049379-1205 UT Primary

Addresses

Primary practice location

50 E 9000 S
Sandy, UT 84070-2201

Mailing address

PO Box 71840
Salt Lake City, UT 84171-0840
Phone (801) 809-9471

National Provider Directory

National Provider Directory

Locations

50 E 9000 S
#G
Sandy, UT 84070
Phone (801) 561-9839

NPI Registry JSON

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

{
    "created_epoch": "1203292800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1208390400000",
    "number": "1770751323",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 71840",
            "city": "SALT LAKE CITY",
            "state": "UT",
            "postal_code": "841710840",
            "telephone_number": "801-809-9471",
            "fax_number": "801-572-1497"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "50 E 9000 S",
            "city": "SANDY",
            "state": "UT",
            "postal_code": "840702201",
            "telephone_number": "801-561-9839"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MEDICAL DIRECTOR SERVICES, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-02-18",
        "last_updated": "2008-04-17",
        "status": "A",
        "authorized_official_last_name": "WILLESEN",
        "authorized_official_first_name": "KAVITA",
        "authorized_official_middle_name": "G",
        "authorized_official_title_or_position": "PRESIDENT/PHYSICIAN",
        "authorized_official_telephone_number": "801-809-9471",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "174400000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Specialist",
            "state": "UT",
            "license": "5049379-1205",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Sandy, UT

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 17, 2008; 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.