Provider Demographics
NPI:1144472911
Name:MAGNUM OPUS TECHNOLOGIES
Entity type:Organization
Organization Name:MAGNUM OPUS TECHNOLOGIES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CREDENTIAL SPECIALIST
Authorized Official - Prefix:
Authorized Official - First Name:LAKISHIA
Authorized Official - Middle Name:
Authorized Official - Last Name:BOYD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:210-293-2753
Mailing Address - Street 1:1572 SUNRISE MEADOW DR
Mailing Address - Street 2:
Mailing Address - City:SANDY
Mailing Address - State:UT
Mailing Address - Zip Code:84093-2433
Mailing Address - Country:US
Mailing Address - Phone:801-631-2992
Mailing Address - Fax:
Practice Address - Street 1:1572 SUNRISE MEADOW DR
Practice Address - Street 2:
Practice Address - City:SANDY
Practice Address - State:UT
Practice Address - Zip Code:84093-2433
Practice Address - Country:US
Practice Address - Phone:801-631-2992
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-10-10
Last Update Date:2008-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT354030-3102302R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes302R00000XManaged Care OrganizationsHealth Maintenance Organization