Provider Demographics
NPI:1457596801
Name:OGDEN PULMONARY ASSOCIATES PLLC
Entity Type:Organization
Organization Name:OGDEN PULMONARY ASSOCIATES PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:GURJEET
Authorized Official - Middle Name:S
Authorized Official - Last Name:GROVER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:801-791-7798
Mailing Address - Street 1:PO BOX 150627
Mailing Address - Street 2:
Mailing Address - City:OGDEN
Mailing Address - State:UT
Mailing Address - Zip Code:84415-0627
Mailing Address - Country:US
Mailing Address - Phone:385-492-4930
Mailing Address - Fax:385-492-4449
Practice Address - Street 1:5957 FASHION POINT DR STE 103
Practice Address - Street 2:
Practice Address - City:OGDEN
Practice Address - State:UT
Practice Address - Zip Code:84403-5180
Practice Address - Country:US
Practice Address - Phone:385-492-4930
Practice Address - Fax:385-492-4449
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-12-12
Last Update Date:2023-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
207RC0200X
UT163985-1205207RP1001X, 207RP1001X
UT184694-1205207RP1001X
UT173045-1205207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary DiseaseGroup - Multi-Specialty
Yes207RC0200XAllopathic & Osteopathic PhysiciansInternal MedicineCritical Care MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT304666417021Medicaid
UT528580565045Medicaid
UT251457528002Medicaid
UT002425759021Medicaid
UT000012770Medicare PIN
UT002425759021Medicaid
UT000011955Medicare PIN
UT304666417021Medicaid