Provider Demographics
NPI:1740354653
Name:PREVENTION & MEDICAL SCREENING INC
Entity type:Organization
Organization Name:PREVENTION & MEDICAL SCREENING INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CORPORATION PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:LOMBARDO
Authorized Official - Middle Name:FRANCISCO
Authorized Official - Last Name:PALMA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:801-417-8062
Mailing Address - Street 1:3540 S 4000 W
Mailing Address - Street 2:#200
Mailing Address - City:WEST VALLEY
Mailing Address - State:UT
Mailing Address - Zip Code:84120-3260
Mailing Address - Country:US
Mailing Address - Phone:801-417-8062
Mailing Address - Fax:801-417-8065
Practice Address - Street 1:3540 S 4000 W
Practice Address - Street 2:#200
Practice Address - City:WEST VALLEY CITY
Practice Address - State:UT
Practice Address - Zip Code:84120-3260
Practice Address - Country:US
Practice Address - Phone:801-417-8062
Practice Address - Fax:801-417-8065
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-20
Last Update Date:2024-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT1695411205207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT07376 =========008Medicaid
UT000002292Medicare ID - Type Unspecified
UT07376 =========008Medicaid