Provider Demographics
NPI:1437209186
Name:LAKEVIEW PROFESSIONAL BILLING
Entity Type:Organization
Organization Name:LAKEVIEW PROFESSIONAL BILLING
Other - Org Name:HOSPITAL CORPORATION OF UTAH
Other - Org Type:Doing Business As
Authorized Official - Title/Position:BILLER
Authorized Official - Prefix:
Authorized Official - First Name:TENNILEL
Authorized Official - Middle Name:
Authorized Official - Last Name:MICHAELIS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:801-299-7802
Mailing Address - Street 1:PO BOX 639
Mailing Address - Street 2:
Mailing Address - City:BOUNTIFUL
Mailing Address - State:UT
Mailing Address - Zip Code:84011-0639
Mailing Address - Country:US
Mailing Address - Phone:801-299-7802
Mailing Address - Fax:801-299-7803
Practice Address - Street 1:630 MEDICAL DR
Practice Address - Street 2:
Practice Address - City:BOUNTIFUL
Practice Address - State:UT
Practice Address - Zip Code:84010-4908
Practice Address - Country:US
Practice Address - Phone:801-299-7802
Practice Address - Fax:801-299-7803
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-12
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT167432-1205225B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225B00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPulmonary Function TechnologistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT529660595001Medicaid
UT529660595001Medicaid