Provider Demographics
NPI:1194969493
Name:PATRICIA BEARNSON MD PC
Entity type:Organization
Organization Name:PATRICIA BEARNSON MD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:PATRICIA
Authorized Official - Middle Name:
Authorized Official - Last Name:BEARNSON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:801-272-6100
Mailing Address - Street 1:4465 S 900 E STE 275
Mailing Address - Street 2:
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84124-2469
Mailing Address - Country:US
Mailing Address - Phone:801-272-6100
Mailing Address - Fax:801-272-6101
Practice Address - Street 1:4465 S 900 E STE 275
Practice Address - Street 2:
Practice Address - City:SALT LAKE CITY
Practice Address - State:UT
Practice Address - Zip Code:84124-2469
Practice Address - Country:US
Practice Address - Phone:801-878-7103
Practice Address - Fax:801-272-6101
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-04-30
Last Update Date:2012-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT173454-1205207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
UTE27804Medicare UPIN
UT000011483Medicare PIN