Provider Demographics
NPI:1326492109
Name:PENNINGTON MEDICAL CENTER
Entity Type:Organization
Organization Name:PENNINGTON MEDICAL CENTER
Other - Org Name:PENNINGTON WOMEN'S CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:
Authorized Official - Last Name:PENNINGTON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:801-719-8395
Mailing Address - Street 1:3507 N UNIVERSITY AVE STE 175
Mailing Address - Street 2:
Mailing Address - City:PROVO
Mailing Address - State:UT
Mailing Address - Zip Code:84604-6692
Mailing Address - Country:US
Mailing Address - Phone:801-719-8395
Mailing Address - Fax:
Practice Address - Street 1:3507 N UNIVERSITY AVE STE 175
Practice Address - Street 2:
Practice Address - City:PROVO
Practice Address - State:UT
Practice Address - Zip Code:84604-6692
Practice Address - Country:US
Practice Address - Phone:801-719-8395
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-04-19
Last Update Date:2016-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT5665828-1205207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Multi-Specialty