Healthcare Provider Details

I. General information

NPI: 1699010769
Provider Name (Legal Business Name): JOANNE SUMPIO HINSON MD PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/30/2012
Last Update Date: 07/08/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

24 S 1100 E STE 210
SALT LAKE CITY UT
84102-1500
US

IV. Provider business mailing address

24 S 1100 E STE 210
SALT LAKE CITY UT
84102-1500
US

V. Phone/Fax

Practice location:
  • Phone: 801-364-4030
  • Fax: 801-364-4208
Mailing address:
  • Phone: 801-364-4030
  • Fax: 801-364-4208

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207VG0400X
TaxonomyGynecology Physician
License Number2756871205
License Number StateUT

VIII. Authorized Official

Name: JOANNE SUMPIO HINSON
Title or Position: PRESIDENT
Credential: MD
Phone: 801-364-4030