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NPI Code Detail

MEDICARE: PDY CORP

MEDICARE: PDY CORP
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
1251S00000XCommunity/Behavioral Health Agency1025453501UT

Medicare Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1U000078304OTHERUTMEDICARE PTAN#

General Provider Information

NPI Number : 1760839484
Entity Type Code : Organization
Provider Name (Legal Business Name) : PDY CORP
Provider Business Mailing Address
First Line : 3232 S 1575 E
Second Line :
City : SALT LAKE CITY
State : UT
Zip : 84106-3355
Country : US
Telephone Number : 801-755-0928
Fax Number :
Provider Business Practice Location Address
First Line : 2319 S FOOTHILL DR STE 180
Second Line :
City : SALT LAKE CITY
State : UT
Zip : 84109-5403
Country : US
Telephone Number : 801-755-0928
Fax Number :
Authorized Official
Title or Position : PRESIDENT
Name : PATRICIA RUTH DEYOUNG
Credential : LCSW
Telephone Number : 801-755-0928
Provider Enumeration Date : 05/23/2016
Last Update Date : 05/23/2016

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Directions to “PDY CORP ” Practice Location

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