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NPI Code Detail

MEDICARE: ANDY ZANE DEINES

MEDICARE: ANDY ZANE DEINES
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1171M00000XCase Manager/Care Coordinator

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1164834462OTHERUTDRIVERS LICENSE

General Provider Information

NPI Number : 1144795303
Entity Type Code : Individual
Provider Name (Legal Business Name) : ANDY ZANE DEINES
Provider Business Mailing Address
First Line : PO BOX 520009
Second Line :
City : SALT LAKE CITY
State : UT
Zip : 84152-0009
Country : US
Telephone Number : 801-281-1100
Fax Number : 801-281-1936
Provider Business Practice Location Address
First Line : 716 E 4500 S STE N160
Second Line :
City : MURRAY
State : UT
Zip : 84107-3617
Country : US
Telephone Number : 801-281-1100
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/03/2018
Last Update Date : 10/03/2018

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Directions to “ ANDY ZANE DEINES ” Practice Location

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