Provider Demographics
NPI:1326257221
Name:PLONOWSKI, JAMES THOMAS (SSW)
Entity Type:Individual
Prefix:
First Name:JAMES
Middle Name:THOMAS
Last Name:PLONOWSKI
Suffix:
Gender:M
Credentials:SSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:440 N PAIUTE DR
Mailing Address - Street 2:
Mailing Address - City:CEDAR CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84721-6181
Mailing Address - Country:US
Mailing Address - Phone:435-586-1112
Mailing Address - Fax:435-586-7388
Practice Address - Street 1:440 N PAIUTE DR
Practice Address - Street 2:
Practice Address - City:CEDAR CITY
Practice Address - State:UT
Practice Address - Zip Code:84721-6181
Practice Address - Country:US
Practice Address - Phone:435-586-1112
Practice Address - Fax:435-586-7388
Is Sole Proprietor?:No
Enumeration Date:2007-05-21
Last Update Date:2009-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT870365095Medicaid
UTPLONOJOtherSBHC STAFF CODE