Provider Demographics
NPI:1770631194
Name:MOUNTAIN WEST EAR NOSE AND THROAT LC
Entity Type:Organization
Organization Name:MOUNTAIN WEST EAR NOSE AND THROAT LC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:GEN.
Authorized Official - Prefix:DR
Authorized Official - First Name:CURT
Authorized Official - Middle Name:R
Authorized Official - Last Name:STOCK
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:801-295-5581
Mailing Address - Street 1:2255 N 1700 W
Mailing Address - Street 2:SUITE 200
Mailing Address - City:LAYTON
Mailing Address - State:UT
Mailing Address - Zip Code:84041-1140
Mailing Address - Country:US
Mailing Address - Phone:801-776-2180
Mailing Address - Fax:801-776-2534
Practice Address - Street 1:1551 RENAISSANCE TOWNE DR
Practice Address - Street 2:SUITE 310
Practice Address - City:BOUNTIFUL
Practice Address - State:UT
Practice Address - Zip Code:84010-7667
Practice Address - Country:US
Practice Address - Phone:801-295-5581
Practice Address - Fax:801-295-9253
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-08
Last Update Date:2010-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT264339-1205207Y00000X
UT178486-1205207Y00000X
UT188579-1205207Y00000X
WY5395A207Y00000X
WY5387A207Y00000X
UT182660-1205207YP0228X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngologyGroup - Single Specialty
No207YP0228XAllopathic & Osteopathic PhysiciansOtolaryngologyPediatric OtolaryngologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WY124257100Medicaid
WY108796700Medicaid
UTDA4984OtherRAILROAD MEDICARE
WY124257100Medicaid