Provider Demographics
NPI:1437294253
Name:SOUTH VALLEY RHEUMATOLOGY PC
Entity Type:Organization
Organization Name:SOUTH VALLEY RHEUMATOLOGY PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PARTNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MAX
Authorized Official - Middle Name:S
Authorized Official - Last Name:LUNDBERG
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:801-571-4100
Mailing Address - Street 1:11333 S 1000 E
Mailing Address - Street 2:SUITE 100
Mailing Address - City:SANDY
Mailing Address - State:UT
Mailing Address - Zip Code:84094-5429
Mailing Address - Country:US
Mailing Address - Phone:801-571-4100
Mailing Address - Fax:801-571-4125
Practice Address - Street 1:11333 S 1000 E
Practice Address - Street 2:SUITE 100
Practice Address - City:SANDY
Practice Address - State:UT
Practice Address - Zip Code:84094-5429
Practice Address - Country:US
Practice Address - Phone:801-571-4100
Practice Address - Fax:801-571-4125
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-20
Last Update Date:2012-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RR0500XAllopathic & Osteopathic PhysiciansInternal MedicineRheumatologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT00005535Medicare ID - Type Unspecified