1. Home
  2. Directory
  3. Utah
  4. Providence
  5. Dermatology
  6. NPI Profile

PROVIDENCE DERMATOLOGY LLC
NPI 1568029957
Dermatology in Providence, UT

Active since May 22, 2019CLIA 46D2171742 · Certificate of Compliance
169 N GATEWAY DR STE 100, PROVIDENCE, UT 84332(541) 999-4475 Get Directions Write a Review

NPPES record last updated: June 16, 2025. Verified against the NPPES registry weekly; last sync: August 09, 2026.

Record update history: Jun 16, 2025, May 15, 2024, Sep 10, 2019 and 2 more (5 updates tracked since 2019).

About Providence Dermatology Llc NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

PROVIDENCE DERMATOLOGY LLC (NPI 1568029957), doing business as Providence Dermatology, is a healthcare organization registered as a dermatology in Providence, Utah and active in the NPI registry since May 2019. The organization holds a CLIA Certificate of Compliance certificate valid through June 7, 2027, maintains a secondary practice location in Brigham City, and lists Travis S James, Owner/physician, as its authorized official.

NPPES Registry Identity

NPI1568029957
Entity TypeOrganization
Primary Taxonomy207N00000X
Legal Business NamePROVIDENCE DERMATOLOGY LLC
Location Address169 N GATEWAY DR STE 100Providence, UT 84332-9860
Mailing Address169 N Gateway Dr Ste 100Providence, UT 84332-9860 · (435) 554-1182 · Fax (435) 554-1950
Phone(541) 999-4475
Organization SubpartNo
Authorized OfficialTravis S JamesOwner/physician · (435) 554-1182
Enumeration DateMay 22, 2019
Last NPPES UpdateJune 16, 20255 updates tracked since enumeration
NPPES CertifiedJune 16, 2025
✔ NPI 1568029957 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses 2

★ Primary SpecialtyDermatologyAllopathic & Osteopathic Physicians
Taxonomy Code207N00000X
Definition
A dermatologist is trained to diagnose and treat pediatric and adult patients with benign and malignant disorders of the skin, mouth, external genitalia, hair and nails, as well as a number of sexually transmitted diseases. The dermatologist has had additional training and experience in the diagnosis and treatment of skin cancers, melanomas, moles and other tumors of the skin, the management of contact dermatitis and other allergic and nonallergic skin disorders, and in the recognition of the skin manifestations of systemic (including internal malignancy) and infectious diseases. Dermatologists have special training in dermatopathology and in the surgical techniques used in dermatology. They also have expertise in the management of cosmetic disorders of the skin such as hair loss and scars and the skin changes associated with aging.
Also ListedDermatology · MOHS-Micrographic SurgeryTaxonomy 207ND0101X
169 N GATEWAY DR STE 100, Providence, UT 84332
Open in Google Maps ↗

Other Names 1

Doing Business AsProvidence Dermatology

Secondary Practice Location 1

Location 1950 Medical Dr Ste 311Brigham City, UT 84302-4724 · Phone (435) 554-1182 · Fax (435) 554-1950

Group Practice 1

Group TaxonomyThis provider is a business group of one or more individual practitioners, who practice with different areas of specialization.193200000X MULTI-SPECIALTY GROUP

Accepted Insurance

The full list of accepted plans is on the Insurance tab. Issuers include BridgeSpan Health Company, Molina Healthcare, Regence BlueCross BlueShield of Utah and more.Insurance ›

CLIA Laboratory Certificates CMS CLIA

Laboratory certificates issued under the Clinical Laboratory Improvement Amendments (CLIA) program, which sets federal quality standards for human laboratory testing in the United States. There is no official CMS crosswalk between CLIA and NPI numbers; these certificates are associated with this NPI by matching facility names, locations and phone numbers in the CMS CLIA registry.

Certificate of Compliance 46D2171742

Providence Dermatology · Providence, UT
Active · expires Jun 7, 2027
CLIA Number46D2171742
Laboratory TypePhysician Office
Certificate Effective DateJune 8, 2025
Certificate Expiration DateJune 7, 2027
Laboratory DirectorTravis S. James
Laboratory Phone(435) 554-1182
Laboratory LocationProvidence Dermatology169 N Gateway Drive Suite 100, Providence, UT 84332
CLIA data matches this NPI record on: Address Name Phone
This certificate is issued to a laboratory after an inspection that finds the laboratory to be in compliance with all applicable CLIA requirements.

Other Providers at the Same Location NPPES 2

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

DR. TRAVIS JAMES DO
Dermatology
169 N GATEWAY DR STE 100
PROVIDENCE, UT 84332
Cache County (435) 554-1182
DR. CORY B MAUGHAN D.O.
Dermatology (MOHS-Micrographic Surgery)
169 N GATEWAY DR STE 100
PROVIDENCE, UT 84332
Cache County (541) 999-4475

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Providence Dermatology LLC's NPI number?

The NPI number for Providence Dermatology LLC is 1568029957. It was assigned to this organization in the NPPES registry on May 22, 2019. The provider is doing business as Providence Dermatology.

Where is Providence Dermatology LLC located?

Providence Dermatology LLC is located at 169 N Gateway Dr Ste 100, Providence, UT 84332. The listed phone number is (541) 999-4475.

What is Providence Dermatology LLC's specialty?

The primary specialty registered for this NPI is Dermatology with taxonomy code 207N00000X.

Does Providence Dermatology LLC hold a CLIA laboratory certificate?

Yes. A Certificate of Compliance (number 46D2171742) is associated with this NPI, valid through June 7, 2027. CLIA certificates authorize laboratory testing under the federal Clinical Laboratory Improvement Amendments program.

What insurance does Providence Dermatology LLC accept?

Health plans from BridgeSpan Health Company, Molina Healthcare, Regence BlueCross BlueShield of Utah and University of Utah Health Plans list Providence Dermatology LLC as in-network in at least one marketplace plan. Coverage varies by plan and year; verify with the insurer or the provider before a visit.

When was this NPI record last updated?

The NPPES record for Providence Dermatology LLC was last updated on June 16, 2025. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 13 months ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.