MOBILE VIVITROL, LLC – NPI #1033742994
Family Medicine

A family medicine physician who specializes in the diagnosis and treatment of addictions.

Health Care Provider Taxonomy Code for Family Medicine

MOBILE VIVITROL, LLC is a provider located in DRAPER, UT. NPPES has assigned the NPI number 1033742994 to MOBILE VIVITROL, LLC on February 19, 2020. It is a Type-2 NPI, indicating this NPI number is associated with an organization. The primary taxonomy selected by this provider is 207QA0401X from the Health Care Provider Taxonomy code set, which is classified as Family Medicine, specializing in Addiction Medicine

The NPI profile was previously updated about 5 years ago on Mar 12, 2021. Use the NPI data found here to bill health insurance companies, identify providers enrolled in Medicare and Medicaid services or other HIPAA compliant transactions. See the complete NPI profile for MOBILE VIVITROL, LLC below.

NPI Profile for
MOBILE VIVITROL, LLC

NPI Number
1033742994
Enumeration Date

(more than 6 years ago)
Entity Type
Type-2  Organization
Organization health care providers may have a single employee or thousands of employees. An example is an incorporated individual who is an organization's only employee.
Legal Name
MOBILE VIVITROL, LLC
Primary location
13032 SNOW CREST CR
DRAPER, UT 84020
Phone: (801) 898-7778 Fax:
Mailing address
PO BOX 639
DRAPER, UT 84020
Phone: (801) 558-6564 Fax:
Organization Subpart
No
Authorized Official
MARK RICHARDS
OWNER
Phone: (801) 898-7778
Updated
Certification Date
Mar 12, 2021

Note: NPPES allows providers to attest to the accuracy of their NPI data. When a provider request any change to the NPI record, they will be able to attest to their changed NPI data, resulting in an updated certification date.

Taxonomy Code(s)

A taxonomy code is a code that describes the health care service provider's type, classification, and the area of specialization. The primary specialty for this provider is indicated as (Primary) below.

Taxonomy Classification / Specialization State License
207QA0401X
- Family Medicine / Addiction Medicine (Primary)

The taxonomy codes are selected by the provider at the time of NPI registration. Selection of a taxonomy code does not replace any credentialing or validation process that the provider requesting the code should complete.