Provider Demographics
NPI:1245648468
Name:RICHARD W. PARKINSON
Entity type:Organization
Organization Name:RICHARD W. PARKINSON
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:
Authorized Official - Last Name:PARKINSON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:801-224-8484
Mailing Address - Street 1:5314 NORTH 250 WEST, STE 220
Mailing Address - Street 2:
Mailing Address - City:PROVO
Mailing Address - State:UT
Mailing Address - Zip Code:84604
Mailing Address - Country:US
Mailing Address - Phone:801-225-8484
Mailing Address - Fax:801-225-6170
Practice Address - Street 1:5314 N 250 W STE 220
Practice Address - Street 2:
Practice Address - City:PROVO
Practice Address - State:UT
Practice Address - Zip Code:84604-7746
Practice Address - Country:US
Practice Address - Phone:801-225-8484
Practice Address - Fax:801-225-6170
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-07-31
Last Update Date:2014-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT62460808900261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center