Provider Demographics
NPI:1598009136
Name:IAA DRAPER INC
Entity Type:Organization
Organization Name:IAA DRAPER INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:DUANE
Authorized Official - Middle Name:
Authorized Official - Last Name:HARRIS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:801-553-1900
Mailing Address - Street 1:12422 S 450 E
Mailing Address - Street 2:SUITE C
Mailing Address - City:DRAPER
Mailing Address - State:UT
Mailing Address - Zip Code:84020-8050
Mailing Address - Country:US
Mailing Address - Phone:801-553-1900
Mailing Address - Fax:801-553-9995
Practice Address - Street 1:12422 S 450 E
Practice Address - Street 2:SUITE C
Practice Address - City:DRAPER
Practice Address - State:UT
Practice Address - Zip Code:84020-8050
Practice Address - Country:US
Practice Address - Phone:801-553-1900
Practice Address - Fax:801-553-9995
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-11-20
Last Update Date:2013-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM2500XAmbulatory Health Care FacilitiesClinic/CenterMedical Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
UTU000078816Medicare PIN