Healthcare Provider Details

I. General information

NPI: 1356685903
Provider Name (Legal Business Name): IAA OGDEN INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/20/2012
Last Update Date: 12/27/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5929 FASHION POINT DR #101
SOUTH OGDEN UT
84403-4672
US

IV. Provider business mailing address

5929 FASHION POINT DR #101
SOUTH OGDEN UT
84403-4672
US

V. Phone/Fax

Practice location:
  • Phone: 801-476-0052
  • Fax: 801-476-0064
Mailing address:
  • Phone: 801-476-0052
  • Fax: 801-476-0064

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM2500X
TaxonomyMedical Specialty Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DR. JOSEPH ANDERSON
Title or Position: PRESIDENT
Credential:
Phone: 801-476-0052