Provider Demographics
NPI:1669424099
Name:KELSON PHYSICIAN PARTNERS OF LAYTON, INC.
Entity type:Organization
Organization Name:KELSON PHYSICIAN PARTNERS OF LAYTON, INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:COO/ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:MATT
Authorized Official - Middle Name:
Authorized Official - Last Name:WEST
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:801-927-1571
Mailing Address - Street 1:2086 N. 1700 W
Mailing Address - Street 2:SUITE C
Mailing Address - City:LAYTON
Mailing Address - State:UT
Mailing Address - Zip Code:84041
Mailing Address - Country:US
Mailing Address - Phone:801-773-8644
Mailing Address - Fax:801-927-1591
Practice Address - Street 1:2086 N. 1700 W (ROBBINS DRIVE)
Practice Address - Street 2:SUITE C
Practice Address - City:LAYTON
Practice Address - State:UT
Practice Address - Zip Code:84041-1118
Practice Address - Country:US
Practice Address - Phone:801-773-8644
Practice Address - Fax:801-927-1591
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-16
Last Update Date:2011-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
=========OtherTIN