Provider Demographics
NPI:1790976801
Name:RICHARD BOYCE CRNA PC
Entity Type:Organization
Organization Name:RICHARD BOYCE CRNA PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:A
Authorized Official - Last Name:BOYCE
Authorized Official - Suffix:
Authorized Official - Credentials:CRNA
Authorized Official - Phone:801-392-0385
Mailing Address - Street 1:PO BOX 837
Mailing Address - Street 2:
Mailing Address - City:OGDEN
Mailing Address - State:UT
Mailing Address - Zip Code:84402-0837
Mailing Address - Country:US
Mailing Address - Phone:801-392-0385
Mailing Address - Fax:801-393-3334
Practice Address - Street 1:3480 WASHINGTON BLVD STE 105
Practice Address - Street 2:
Practice Address - City:OGDEN
Practice Address - State:UT
Practice Address - Zip Code:84401-4149
Practice Address - Country:US
Practice Address - Phone:801-392-0385
Practice Address - Fax:801-393-3334
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-05
Last Update Date:2017-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT972163844406367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified RegisteredGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT528981950011Medicaid