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General NPI Number Information
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NPI Number | 1417120650
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Entity Type | Organization
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Legal Business Name | LAKEVIEW PROFESSIONAL BILLING, LLC
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Dates
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Enumeration Date | 04/09/2008
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Last Update Date | 04/09/2008
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Provider Practice Location Address
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Address Line | 630 MEDICAL DR
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City | BOUNTIFUL
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State | UT
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Zip | 84010-4908
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Country | US
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Telephone | 801-299-2200
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Fax | 801-299-2392
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Provider Business Mailing Address
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Address Line | 630 MEDICAL DR
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City | BOUNTIFUL
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State | UT
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Zip | 84010-4908
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Country | US
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Telephone | 801-299-2200
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Fax | 801-299-2392
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Authorized Official
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Title or Position | CFO
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Name | WAYNE J DALTON
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Credential |
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Telephone | 801-299-2501
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number | 2007-HOSP-189
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License Number State | UT
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