Provider Demographics
NPI:1154750149
Name:BRETT LUDDINGTON, INC.
Entity type:Organization
Organization Name:BRETT LUDDINGTON, INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:BRETT
Authorized Official - Middle Name:SPIERS
Authorized Official - Last Name:LUDDINGTON
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:801-981-8795
Mailing Address - Street 1:7430 S CREEK RD
Mailing Address - Street 2:STE 104
Mailing Address - City:SANDY
Mailing Address - State:UT
Mailing Address - Zip Code:84093-6158
Mailing Address - Country:US
Mailing Address - Phone:801-981-8795
Mailing Address - Fax:801-987-8051
Practice Address - Street 1:7430 S CREEK RD
Practice Address - Street 2:STE 104
Practice Address - City:SANDY
Practice Address - State:UT
Practice Address - Zip Code:84093-6158
Practice Address - Country:US
Practice Address - Phone:801-981-8795
Practice Address - Fax:801-987-8051
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-11-11
Last Update Date:2014-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT4806041-1202261QM1300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
UTU000086375OtherMEDICARE ID