PROVIDENCE DERMATOLOGY LLC
NPI 1568029957
Dermatology in Providence, UT
NPI Status: Active since May 22, 2019
Contact Information
169 N GATEWAY DR STE 100
PROVIDENCE, UT
ZIP 84332
Phone: (541) 999-4475
- Organization
- Dermatology
- Accepts Insurance
- CLIA Number: 46D2171742
- CLIA Cert. Type: Physician Office
- CLIA Exp. Date: 06-07-2027
About PROVIDENCE DERMATOLOGY LLC
This page provides the complete NPI Profile along with additional information for Providence Dermatology Llc, a provider established in Providence, Utah operating as a Dermatology. The healthcare provider is registered in the NPI registry with number 1568029957 assigned on May 2019. The practitioner's primary taxonomy code is 207N00000X. The provider is registered as an organization and their NPI record was last updated one year ago. Providence Dermatology Llc operates as a Multi-Specialty Group with one or more individual practitioners, who practice different areas of specialization. The provider's
- NPI
- 1568029957
- Provider Legal Name
- PROVIDENCE DERMATOLOGY LLC
- Other Organization Name
- Other Name Type
- (6)
- Entity Type
- Organization
- Location Address
- 169 N GATEWAY DR STE 100 PROVIDENCE, UT 84332
- Location Phone
- (541) 999-4475
- Mailing Address
- 169 N GATEWAY DR STE 100 PROVIDENCE, UT 84332
- Mailing Phone
- (435) 554-1182
- Mailing Fax
- Is Sole Proprietor?
- No
- Is Organization Subpart?
- No
- Enumeration Date
- 05-22-2019
- Last Update Date
- 06-16-2025
- Code Navigator
A dermatologist like Providence Dermatology Llc is a medical specialty involving the management of skin conditions and diseases. Dermatologists diagnose some sexually transmitted diseases, warts, cancer, acne, dermatitis and may offer cosmetic treatments, and therapies that reduce age spots and wrinkles.
Location Map
Secondary Locations
- 950 Medical Dr Ste 311
Brigham City, UT 84302
(435) 554-1182
Specialty - Primary Taxonomy
The NPI enumerator requires providers to submit at least one taxonomy code. A taxonomy code is a unique 10-character code that describes the healthcare provider type, classification, and the area of specialization. There could be only one primary taxonomy code per NPI record. For individual NPIs the license data is associated to the taxonomy code.
- Classification
Dermatology
- Taxonomy Code
- 207N00000X
- Type
- Allopathic & Osteopathic Physicians
- Taxonomy Description
- 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.
Secondary Taxonomies
The provider has reported to the NPI enumerator additional taxonomy codes. Multiple taxonomy codes may represent subspecialties or other areas of specialization the provider maybe licensed to practice.
| No. | Taxonomy Code | Type | Classification / Specialization |
License No. (State) |
|---|---|---|---|---|
| 1 | 207ND0101X | Allopathic & Osteopathic Physicians | Dermatology |
Group Taxonomy 193200000X MULTI-SPECIALTY GROUP
This provider is a business group of one or more individual practitioners, who practice with different areas of specialization.
Insurance Plans Accepted
According to publicly available information the provider might be accepting the following health plans from these health insurance companies:
- BridgeSpan Standard Bronze Plan - HMO
- BridgeSpan Standard Gold Plan - HMO
- BridgeSpan Standard Silver Plan - HMO
- Molina Gold Core 1640 - HMO
- Molina Gold Core 1640 Plus with Adult Dental and Vision - HMO
- Molina Gold Standard - HMO
- Molina Silver Core - HMO
- Molina Silver Core Plus with Adult Dental and Vision - HMO
- Molina Silver Core Plus with Adult Vision - HMO
- Molina Silver Saver with Four Free PCP Visits - HMO
- Molina Silver Standard - HMO
- Bronze 8000 - EPO
- Bronze Essential 9000 Deductible With 4 Copay No Deductible Office Visits - EPO
- Bronze HSA 7000 - EPO
- Gold 2300 - EPO
- Regence Standard Bronze 7500 - EPO
- Regence Standard Gold 2000 - EPO
- Regence Standard Silver 6000 - EPO
- Silver 6500 - EPO
- Healthy Premier Bronze HSA - EPO
- Healthy Premier Expanded Bronze Standard - EPO
- Healthy Premier Gold Copay Office Visits - EPO
- Healthy Premier Gold Standard - EPO
- Healthy Premier Silver Copay Office Visits - EPO
- Healthy Premier Silver Standard - EPO
*Please verify directly with this provider to make sure your insurance plan is currently accepted.
CLIA Information
The Clinical Laboratory Improvement Amendments (CLIA) of 1988 applies to facilities or sites that test human specimens for health assessment or to diagnose, prevent, or treat disease. The CLIA Program sets standards for clinical laboratory testing and issues certificates. The NPI / CLIA crosswalk information for this NPI number is:
- CLIA Number
- 46D2171742
- Facility Type
- Physician Office
- Certificate Effective Date
- June 08, 2025
- Certificate Expiration Date
- June 07, 2027
- Laboratory Director
- TRAVIS S. JAMES
- Certificate Type
- Certificate of Compliance
- Certificate Type Description
- This CLIA certificate is issued to Providence Dermatology Llc after an inspection that finds the laboratory to be in compliance with all applicable CLIA requirements. This type of certificate is issued to laboratories that perform nonwaived (moderate and/or high complexity) testing.
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NPI NPI Number Validation
How NPI Validation Works
The NPI validation process uses the ISO-standard Luhn algorithm, a mathematical "handshake", to ensure that a provider's 10-digit ID is authentic and free of common typing errors.
To verify the NPI 1568029957, we treat the final digit (7) as the Check Digit—the target answer we need to reach. The process begins by taking the first nine digits and adding a constant value of 24, which accounts for the "80840" prefix required for all U.S. health identifiers. We then double every other digit starting from the right and sum the individual digits of those results together. For this specific NPI, that total comes to 63. The final step is to find the difference between that total and the next multiple of ten (70 - 63 = 7).
Digit-by-digit view
Use the first nine digits for the calculation. Starting from the right, double every other digit. The last digit is the check digit and is not part of the calculation.
Step 1: Double every other digit from the right
Starting with the rightmost digit of the first nine digits, double every other value. If doubling creates a two-digit number, add those digits together.
Step 2: Add all digits plus the NPI constant
Add the transformed values, the unchanged digits, and the constant 24.
Step 3: Find the amount needed to reach the next multiple of 10
The next multiple of ten after 63 is 70. The difference is the calculated check digit.
Other Providers at the Same Location
The following 2 providers are registered at the same or a nearby location.
PROVIDENCE, UT 84332
Frequently Asked Questions
The NPI number assigned to this healthcare provider is 1568029957, enumerated as an "organization" on May 22, 2019.
The provider is located at 169 N GATEWAY DR STE 100 PROVIDENCE, UT 84332 and the phone number is (541) 999-4475.
Dermatology with taxonomy code 207N00000X.
The provider might be accepting Accepts: BridgeSpan Health Company, Molina Healthcare,. Please consult your insurance carrier or call the provider to verify.
