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Contact Information

MOUNTAIN WEST EAR NOSE AND THROAT LC
1551 RENAISSANCE TOWNE DR
SUITE 310
BOUNTIFUL, UT84010-7667
 Phone: 801-295-5581
 Fax: 801-295-9253
 Website:
 

Specialty

Taxonomy Code Specialty Code Provider Type

Otolaryngology

207Y00000X 04 Physician/Otolaryngology
 

Pediatric Otolaryngology

207YP0228X 04 Physician/Otolaryngology
Indicates primary specialty

NPI Profile & details for MOUNTAIN WEST EAR NOSE AND THROAT LC

NPI # 1770631194
LBN Legal business name MOUNTAIN WEST EAR NOSE AND THROAT LC
Authorized official CURT STOCK - (GEN.)
Entity Organization
Organization subpart 1 No
Enumeration date 01/08/2007
Last updated 08/05/2010 - About 16 years ago
Identifiers
UT License # 178486-1205
UT License # 182660-1205
UT License # 188579-1205
UT License # 264339-1205
WY License # 5387A
WY License # 5395A
WY Medicaid 108796700
WY Medicaid 124257100
UT Other DA4984 RAILROAD MEDICARE
1 Some organization health care providers are made up of components that furnish different types of health care or have separate physical locations where health care is furnished. These components and physical locations are not themselves legal entities, but are part of the organization health care provider (which is a legal entity). A covered organization provider may decide that its subparts (if it has any) should have their own NPI numbers. If a subpart conducts any HIPAA standard transactions on its own (e.g., separately from its parent), it must obtain its own NPI number.

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