Provider Demographics
NPI:1063444677
Name:NORTH FAMILY PRACTICE, P.C.
Entity Type:Organization
Organization Name:NORTH FAMILY PRACTICE, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:JASON
Authorized Official - Middle Name:K
Authorized Official - Last Name:NORTH
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:435-867-8050
Mailing Address - Street 1:55 E CANYON COMMERCIAL AVE
Mailing Address - Street 2:
Mailing Address - City:CEDAR CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84720-7784
Mailing Address - Country:US
Mailing Address - Phone:435-867-8050
Mailing Address - Fax:435-867-8083
Practice Address - Street 1:55 E CANYON COMMERCIAL AVE
Practice Address - Street 2:
Practice Address - City:CEDAR CITY
Practice Address - State:UT
Practice Address - Zip Code:84720-7784
Practice Address - Country:US
Practice Address - Phone:435-867-8050
Practice Address - Fax:435-867-8083
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-06
Last Update Date:2007-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT4909906-1204207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT528138334009Medicaid
UT528138334009Medicaid