Provider Demographics
NPI:1134177876
Name:NORTH VALLEY EMERGENCY PHYSICIANS LC
Entity type:Organization
Organization Name:NORTH VALLEY EMERGENCY PHYSICIANS LC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:GROUP HEAD
Authorized Official - Prefix:MR
Authorized Official - First Name:DEAN
Authorized Official - Middle Name:
Authorized Official - Last Name:SHELTON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:877-346-2211
Mailing Address - Street 1:PO BOX 430
Mailing Address - Street 2:
Mailing Address - City:SPANISH FORK
Mailing Address - State:UT
Mailing Address - Zip Code:84660-0430
Mailing Address - Country:US
Mailing Address - Phone:877-346-2211
Mailing Address - Fax:616-975-9827
Practice Address - Street 1:170 N 1100 E
Practice Address - Street 2:
Practice Address - City:AMERICAN FORK
Practice Address - State:UT
Practice Address - Zip Code:84003-2096
Practice Address - Country:US
Practice Address - Phone:877-346-2211
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-05
Last Update Date:2019-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207PE0004XAllopathic & Osteopathic PhysiciansEmergency MedicineEmergency Medical ServicesGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT4580756OtherAETNA
UT=========006Medicaid
UT=========006Medicaid
UTCF8649Medicare PIN