Individual provider Active NPI

Timothy C Hollingsed, MD

  • Surgery Physician
  • West Valley City, UT
National Provider Identifier
1790716181
Registry record updated May 13, 2013
On this page

Key facts

NPPES NPI Registry
Primary specialty
Surgery PhysicianTaxonomy code 208600000X
License
1831771205 Issued in UT
Practice address
3725 W 4100 S
West Valley City, UT 84120
Phone
(801) 965-3600
Fax
(801) 965-3526
NPI assigned
Jul 5, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on May 13, 2013

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Surgery Physician 208600000X 1831771205 UT Primary

Addresses

Primary practice location

3725 W 4100 S
West Valley City, UT 84120

Mailing address

3725 W 4100 S
West Valley City, UT 84120
Phone (801) 965-3600

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in UT
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20031215000993 UT Practitioner - General Surgery 0941107247 Reassigns benefits to 1 organization

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
1831771205UTMDSurgery Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Granger Medical Clinic PC Surgery Current Accepting new patients
Granger Medical Clinic PC CurrentSince Aug 15, 1995 Accepting new patients
Granger Medical Park City CurrentSince Aug 15, 1995 Accepting new patients
Granger Medical Specialists LLC Past Accepting new patients

Locations

12391 S 4000 W
Riverton, UT 84096
Phone (801) 302-1700

3725 W 4100 S
West Valley City, UT 84120
Phone (801) 965-3545

Organizations & group practices 4

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.

NPI Registry JSON

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

{
    "created_epoch": "1152057600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1368403200000",
    "number": "1790716181",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3725 W 4100 S",
            "city": "WEST VALLEY CITY",
            "state": "UT",
            "postal_code": "84120",
            "telephone_number": "801-965-3600",
            "fax_number": "801-965-3526"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3725 W 4100 S",
            "city": "WEST VALLEY CITY",
            "state": "UT",
            "postal_code": "84120",
            "telephone_number": "801-965-3600",
            "fax_number": "801-965-3526"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "HOLLINGSED",
        "first_name": "TIMOTHY",
        "middle_name": "C",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-07-05",
        "last_updated": "2013-05-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208600000X",
            "taxonomy_group": "",
            "desc": "Surgery",
            "state": "UT",
            "license": "1831771205",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in West Valley City, UT

Sources for this page

Verify at the official NPI Registry.