Provider Demographics
NPI:1831394881
Name:PAMELA L. VINCENT, MD CORP
Entity type:Organization
Organization Name:PAMELA L. VINCENT, MD CORP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:AMY
Authorized Official - Middle Name:BETH
Authorized Official - Last Name:HARWARD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:801-437-4888
Mailing Address - Street 1:280 RIVER PARK DR STE 350
Mailing Address - Street 2:
Mailing Address - City:PROVO
Mailing Address - State:UT
Mailing Address - Zip Code:84604-5802
Mailing Address - Country:US
Mailing Address - Phone:801-229-1014
Mailing Address - Fax:801-229-1067
Practice Address - Street 1:280 RIVER PARK DR STE 350
Practice Address - Street 2:
Practice Address - City:PROVO
Practice Address - State:UT
Practice Address - Zip Code:84604-5802
Practice Address - Country:US
Practice Address - Phone:801-229-1014
Practice Address - Fax:801-229-1067
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-19
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT188338-12052084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT562842065001Medicaid
UT562842065001Medicaid