Provider Demographics
NPI:1437489028
Name:LUCINDA BATEMAN MD PC
Entity Type:Organization
Organization Name:LUCINDA BATEMAN MD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:LUCINDA
Authorized Official - Middle Name:
Authorized Official - Last Name:BATEMAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:801-359-7400
Mailing Address - Street 1:1002 E SOUTH TEMPLE STE 408
Mailing Address - Street 2:
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84102-1571
Mailing Address - Country:US
Mailing Address - Phone:801-359-7400
Mailing Address - Fax:801-359-7404
Practice Address - Street 1:1002 E SOUTH TEMPLE STE 408
Practice Address - Street 2:
Practice Address - City:SALT LAKE CITY
Practice Address - State:UT
Practice Address - Zip Code:84102-1571
Practice Address - Country:US
Practice Address - Phone:801-359-7400
Practice Address - Fax:801-359-7404
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-01-05
Last Update Date:2013-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT178153 1205207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT0491073OtherUNITED HEALTHCARE
UT528929987015Medicaid
UTE93295Medicare UPIN
UT528929987015Medicaid