Provider Demographics
NPI:1972674232
Name:LAKEVIEW PROFESSIONAL BILLING LLC
Entity Type:Organization
Organization Name:LAKEVIEW PROFESSIONAL BILLING LLC
Other - Org Name:HOSPITAL CORPORATION OF UTAH
Other - Org Type:Other Name
Authorized Official - Title/Position:BILLING SUPERVISOR
Authorized Official - Prefix:MS
Authorized Official - First Name:SHANAE
Authorized Official - Middle Name:D
Authorized Official - Last Name:PEREZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:801-299-2165
Mailing Address - Street 1:PO BOX 639
Mailing Address - Street 2:
Mailing Address - City:BOUNTIFUL
Mailing Address - State:UT
Mailing Address - Zip Code:84011-0639
Mailing Address - Country:US
Mailing Address - Phone:801-299-2145
Mailing Address - Fax:801-299-7811
Practice Address - Street 1:630 E MEDICAL DR
Practice Address - Street 2:
Practice Address - City:BOUNTIFUL
Practice Address - State:UT
Practice Address - Zip Code:84010
Practice Address - Country:US
Practice Address - Phone:801-299-2165
Practice Address - Fax:801-299-7811
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-10
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT1497971205207R00000X
UT1554671205207R00000X
UT1622661205207R00000X
UT1551991205207R00000X
UT27742911205207RC0000X
UT1686031205207RC0000X
UT1674321205207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Not Answered207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
Not Answered207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Multi-Specialty
Not Answered207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary DiseaseGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT52856630402001Medicaid
UT044424281001Medicaid
UT528443301001Medicaid
UT566476556001Medicaid
UT528763507002Medicaid
C63903Medicare UPIN
D07260Medicare UPIN
UT044424281001Medicaid
D07376Medicare UPIN
D98940Medicare UPIN
F36102Medicare UPIN
D07258Medicare UPIN
UT52958619602001Medicare ID - Type UnspecifiedDR. VAI HANSON
UT528443301001Medicaid
UT52856630402001Medicaid
UT566476556001Medicaid