Provider Demographics
NPI:1831336825
Name:TARHEEL OBGYN PC
Entity type:Organization
Organization Name:TARHEEL OBGYN PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:HENRY
Authorized Official - Middle Name:
Authorized Official - Last Name:LEWIS
Authorized Official - Suffix:III
Authorized Official - Credentials:MD
Authorized Official - Phone:435-781-1011
Mailing Address - Street 1:150 W 100 N
Mailing Address - Street 2:STE S103
Mailing Address - City:VERNAL
Mailing Address - State:UT
Mailing Address - Zip Code:84078-2036
Mailing Address - Country:US
Mailing Address - Phone:435-781-1011
Mailing Address - Fax:435-781-1013
Practice Address - Street 1:150 W 100 N
Practice Address - Street 2:STE S103
Practice Address - City:VERNAL
Practice Address - State:UT
Practice Address - Zip Code:84078-2036
Practice Address - Country:US
Practice Address - Phone:435-781-1011
Practice Address - Fax:435-781-1013
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-01-13
Last Update Date:2009-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT71839501205207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
060751OtherOWNERS DOB