Healthcare Provider Details

I. General information

NPI: 1083998603
Provider Name (Legal Business Name): OGDEN INTERNAL MEDICINE AND UROLOGY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/30/2011
Last Update Date: 09/30/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2950 N CHURCH STREET
LAYTON UT
84040
US

IV. Provider business mailing address

2950 N CHURCH STREET 301
LAYTON UT
84040
US

V. Phone/Fax

Practice location:
  • Phone: 801-546-9441
  • Fax:
Mailing address:
  • Phone: 801-547-0747
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207QG0300X
TaxonomyGeriatric Medicine (Family Medicine) Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207VG0400X
TaxonomyGynecology Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code208800000X
TaxonomyUrology Physician
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: MR. DAVE KANE
Title or Position: VICE PRESIDENT
Credential: VP
Phone: 801-568-5960