Healthcare Provider Details

I. General information

NPI: 1417120650
Provider Name (Legal Business Name): LAKEVIEW PROFESSIONAL BILLING, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/09/2008
Last Update Date: 04/09/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

630 MEDICAL DR
BOUNTIFUL UT
84010-4908
US

IV. Provider business mailing address

630 MEDICAL DR
BOUNTIFUL UT
84010-4908
US

V. Phone/Fax

Practice location:
  • Phone: 801-299-2200
  • Fax: 801-299-2392
Mailing address:
  • Phone: 801-299-2200
  • Fax: 801-299-2392

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number2007-HOSP-189
License Number StateUT

VIII. Authorized Official

Name: WAYNE J DALTON
Title or Position: CFO
Credential:
Phone: 801-299-2501