Provider Demographics
NPI:1669435814
Name:MOUNT TIMPANOGOS WOMENS HEALTH, INC
Entity type:Organization
Organization Name:MOUNT TIMPANOGOS WOMENS HEALTH, INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT OF CORP
Authorized Official - Prefix:
Authorized Official - First Name:EDWARD
Authorized Official - Middle Name:WILLIAM
Authorized Official - Last Name:PARKER
Authorized Official - Suffix:JR
Authorized Official - Credentials:MD
Authorized Official - Phone:801-756-5288
Mailing Address - Street 1:1886 W 800 N
Mailing Address - Street 2:
Mailing Address - City:PLEASANT GROVE
Mailing Address - State:UT
Mailing Address - Zip Code:84062
Mailing Address - Country:US
Mailing Address - Phone:801-756-5288
Mailing Address - Fax:801-756-7589
Practice Address - Street 1:1886 W 800 N
Practice Address - Street 2:
Practice Address - City:PLEASANT GROVE
Practice Address - State:UT
Practice Address - Zip Code:84062
Practice Address - Country:US
Practice Address - Phone:801-756-5288
Practice Address - Fax:801-756-7589
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-04-10
Last Update Date:2008-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UTF58967261QM2500X
207VG0400X, 207VX0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207VX0000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyObstetricsGroup - Multi-Specialty
No261QM2500XAmbulatory Health Care FacilitiesClinic/CenterMedical SpecialtyGroup - Multi-Specialty
No207VG0400XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT000055558Medicare ID - Type Unspecified