Provider Demographics
NPI:1225389810
Name:PARK CITY MEDICAL CENTER
Entity Type:Organization
Organization Name:PARK CITY MEDICAL CENTER
Other - Org Name:PARK CITY MEDICAL CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PHARMACY DIRECTOR/PIC
Authorized Official - Prefix:
Authorized Official - First Name:REBECCA
Authorized Official - Middle Name:
Authorized Official - Last Name:POND
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:435-658-7280
Mailing Address - Street 1:900 ROUND VALLEY DR
Mailing Address - Street 2:
Mailing Address - City:PARK CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84060-7552
Mailing Address - Country:US
Mailing Address - Phone:435-658-7275
Mailing Address - Fax:435-658-7276
Practice Address - Street 1:900 ROUND VALLEY DR
Practice Address - Street 2:
Practice Address - City:PARK CITY
Practice Address - State:UT
Practice Address - Zip Code:84060-7552
Practice Address - Country:US
Practice Address - Phone:435-658-7275
Practice Address - Fax:435-658-7276
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-09-24
Last Update Date:2012-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT7287856-17043336I0012X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336I0012XSuppliersPharmacyInstitutional Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
4612291OtherNCPDP PROVIDER IDENTIFICATION NUMBER