Healthcare Provider Details

I. General information

NPI: 1326230590
Provider Name (Legal Business Name): CASSIA PHYSICIANS BILLING
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/13/2007
Last Update Date: 09/22/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1501 HILAND AVE
BURLEY ID
83318-2682
US

IV. Provider business mailing address

PO BOX 27128
SALT LAKE CITY UT
84127-0128
US

V. Phone/Fax

Practice location:
  • Phone: 801-442-1400
  • Fax: 801-442-0641
Mailing address:
  • Phone: 801-442-1400
  • Fax: 801-442-0641

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QR0200X
TaxonomyRadiology Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code261QM1300X
TaxonomyMulti-Specialty Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: KELLY J HOWARD
Title or Position: DIRECTOR
Credential:
Phone: 801-442-1425