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General NPI Number Information
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NPI Number | 1548303795
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Entity Type | Organization
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Legal Business Name | CACHE VALLEY EAR NOSE & THROAT, PLLC
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Dates
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Enumeration Date | 02/15/2007
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Last Update Date | 06/24/2022
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Provider Practice Location Address
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Address Line | 2245 N 400 E STE 301
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City | NORTH LOGAN
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State | UT
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Zip | 84341-1892
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Country | US
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Telephone | 435-753-7880
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Fax | 435-359-4507
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Provider Business Mailing Address
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Address Line | 2245 N 400 E STE 301
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City | NORTH LOGAN
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State | UT
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Zip | 84341-1892
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Country | US
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Telephone | 435-753-7880
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Fax | 435-359-4507
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Authorized Official
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Title or Position | BILLING SPECIALIST
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Name | LINSEY THALMAN
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Credential |
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Telephone | 435-753-7880
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207YX0007X
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Taxonomy Name | Plastic Surgery within the Head & Neck (Otolaryngology) Physician
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License Number | C97276
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License Number State | UT
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