Healthcare Provider Details

I. General information

NPI: 1194930495
Provider Name (Legal Business Name): BRIGHAM YOUNG UNIVERSITY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/11/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

Y BE FIT, 127 RICHARDS BUILDING BRIGHAM YOUNG UNIVERSITY
PROVO UT
84602
US

IV. Provider business mailing address

B-340 ASB BRIGHAM YOUNG UNIVERSITY
PROVO UT
84602
US

V. Phone/Fax

Practice location:
  • Phone: 801-422-4927
  • Fax:
Mailing address:
  • Phone: 801-422-3760
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code293D00000X
TaxonomyPhysiological Laboratory
License Number
License Number State

VIII. Authorized Official

Name: BRIAN EVANS
Title or Position: CHIEF FINANCIAL OFFICER
Credential:
Phone: 801-422-3760