Organization Active NPI

Vicki J Lyons MD PC

  • Allergy Physician
  • Ogden, UT
National Provider Identifier
1780716563
Registry record updated Oct 16, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
Allergy PhysicianTaxonomy code 207KA0200X
License
272784-1205 Issued in UT
Legal business name
VICKI J LYONS MD PC
Practice address
4403 Harrison Blvd
Suite 4640
Ogden, UT 84403-3271
Phone
(801) 387-4850
Fax
(801) 387-4855
NPI assigned
Mar 9, 2007
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 16, 2015

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

Authorized official

Name
Vicki J Lyons, M.D.NPI 1326013574
Title
Owner
Phone
(801) 387-4850

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Allergy PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 207KA0200X 272784-1205 UT Primary

Addresses

Primary practice location

4403 Harrison Blvd
Suite 4640
Ogden, UT 84403-3271

Mailing address

4403 Harrison Blvd
Suite 4640
Ogden, UT 84403-3271
Phone (801) 387-4850

Other identifiers 1

IdentifierTypeStateIssuer
DA3586OtherUTRAILROAD MEDICARE

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in UT

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20031120000760 UT Part B Supplier - Clinic/Group Practice 4486558566 Receives reassigned benefits from 5 practitioners
Practice locations: Ogden, UT

National Provider Directory

National Provider Directory

Locations

425 E 5350 S
Ste 110
Ogden, UT 84405
Phone (801) 476-0052

4403 Harrison Blvd
Ste 464
Ogden, UT 84403

Practitioners & affiliated clinicians

Practitioners 5

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

NPI Registry JSON

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

{
    "created_epoch": "1173398400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1444953600000",
    "number": "1780716563",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4403 HARRISON BLVD",
            "address_2": "SUITE 4640",
            "city": "OGDEN",
            "state": "UT",
            "postal_code": "844033271",
            "telephone_number": "801-387-4850",
            "fax_number": "801-387-4855"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4403 HARRISON BLVD",
            "address_2": "SUITE 4640",
            "city": "OGDEN",
            "state": "UT",
            "postal_code": "844033271",
            "telephone_number": "801-387-4850",
            "fax_number": "801-387-4855"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "VICKI J LYONS MD PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-03-09",
        "last_updated": "2015-10-16",
        "status": "A",
        "authorized_official_last_name": "LYONS",
        "authorized_official_first_name": "VICKI",
        "authorized_official_middle_name": "J",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "801-387-4850",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "207KA0200X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Allergy & Immunology, Allergy",
            "state": "UT",
            "license": "272784-1205",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAILROAD MEDICARE",
            "identifier": "DA3586",
            "state": "UT"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Ogden, UT

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 16, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.