UNIVERSITY OF UTAH PEDIATRIC SERVICES


Address: 2360 Mullan Rd, Sutie C, Missoula, MT 59808-1811
Phone: 4065429695

UNIVERSITY OF UTAH PEDIATRIC SERVICES (NPI# 1023542388) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).

Provider Overview

Nation Provider ID (NPI) 1023542388
Entity Type Organization
Organization Name UNIVERSITY OF UTAH PEDIATRIC SERVICES
Other Organization Name MISSOULA BONE & JOINT SURGICAL CENTER
Practice Address 2360 Mullan Rd
Sutie C
Missoula
MT 59808-1811
Mailing Address Po Box 841450
Los Angeles
CA 90084-1450
Practice Telephone 4065429695
Mailing Telephone 8012133900
Enumeration Date 2017-04-13
Last Update Date 2020-05-20
Authorized Official Name EDWARD CLARK (DEPARTMENT CHAIR)
Authorized Official Telephone 8015876336
Authorized Official Credential MD
Is Organization Subpart Y
Parent Organization Name UNIVERSITY OF UTAH PEDIATRIC SERVICES

Taxonomy

Primary Taxonomy Code Classification License Number License State Taxonomy Group
N 208000000X Pediatrics Allopathic & Osteopathic Physicians
Y 207XP3100X Orthopaedic Surgery
Specialization: Pediatric Orthopaedic Surgery
Allopathic & Osteopathic Physicians

Other Provider/Organization Names

Other Name Type Code
Missoula Bone & Joint Surgical Center Doing Business As Name - Organization

Other Provider IDs and Locations

NPI Name Taxonomy Address Enumeration
1669918769 University of Utah Pediatric Services Pediatrics 1645 Pancheri Dr, Idaho Falls, ID 83402-3169 2017-01-12
1386257152 University of Utah Pediatric Services Orthopaedic Surgery 9385 S Snowbird Center Dr, Sandy, UT 84092-6249 2020-08-31
1760928865 University of Utah Pediatric Services Internal Medicine 110 Vista Dr, Pocatello, ID 83201-5824 2017-01-12
1235675364 University of Utah Pediatric Services Urology 1645 Pancheri Dr, Idaho Falls, ID 83402-3169 2017-01-12
1104370691 University of Utah Pediatric Services Transplant Surgery 81 N Mario Capecchi Dr, Salt Lake City, UT 84113-1125 2016-08-12
1922552413 University of Utah Pediatric Services Surgery 100 N Mario Capecchi Dr, Salt Lake City, UT 84113-1103 2016-08-12
1578017067 University of Utah Pediatric Services Pediatrics 100 N Mario Capecchi Dr, 1, Salt Lake City, UT 84113-1103 2016-08-12
1568916054 University of Utah Pediatric Services Pediatrics 100 N Mario Capecchi Dr, Salt Lake City, UT 84113-1103 2016-08-12
1245682509 University of Utah Pediatric Services Pediatrics 98 Poplar St, Blackfoot, ID 83221-1758 2016-07-11
1346692605 University of Utah Pediatric Services Pediatrics 450 E Main St, Rexburg, ID 83440-2048 2016-07-11

Office Location

Street Address 2360 MULLAN RD
SUTIE C
City MISSOULA
State MT
Zip Code 59808-1811

Providers in the same location

NPI Name Taxonomy Address Enumeration
1497747802 Kay Lynn Kramer Occupational Therapist 2360 Mullan Rd, Ste D, Missoula, MT 59808-1811 2005-08-22
1891354684 Tasha Nichole Kohlwes Specialist/Technologist 2360 Mullan Rd, Missoula, MT 59808-1811 2019-06-06
1306327317 Sydney Williams Physical Therapist 2360 Mullan Rd, Missoula, MT 59808-1811 2018-08-27
1144754938 University of Utah Adult Services Orthopaedic Surgery 2360 Mullan Rd, Suite C, Missoula, MT 59808-1811 2017-04-18
1689117194 Matea Michelle Depoe Specialist/Technologist 2360 Mullan Rd, Suite D, Missoula, MT 59808-1811 2016-12-01
1972900157 Vincent Keeney Physician Assistant 2360 Mullan Rd, Ste C, Missoula, MT 59808-1811 2014-12-03
1497158208 Emily Beatrice Smith Dietitian, Registered 2360 Mullan Rd, Suite C, Missoula, MT 59808-1811 2014-10-07
1588079016 Cynthia Deann Cleveland Physical Therapist 2360 Mullan Rd, Suite C, Missoula, MT 59808-1811 2014-06-23
1427312438 Jesse Jeffrey Doll Physician Assistant 2360 Mullan Rd, Ste C, Missoula, MT 59808-1811 2012-06-25
1992016679 Mike Kim Tran Physical Therapist 2360 Mullan Rd, Missoula, MT 59808-1811 2010-06-28
Find all providers in the same location

Providers in the same zip code

NPI Name Taxonomy Address Enumeration
1447720875 Megan Elizabeth Galliford Behavioral Analyst 1647 Shindig Dr, Apt 303, Missoula, MT 59808 2018-11-28
1518473560 Willow Mahana Nelson Griffith Registered Nurse 2829 Great Northern Loop Ste 300, Missoula, MT 59808 2017-12-28
1043739428 Carol Elizabeth Mckenzie Student in an Organized Health Care Education/Training Program 2705 Oshaughnessy St, Missoula, MT 59808 2017-09-16
1558884064 Sharon Marie Herndon Nurse Practitioner 2230 N Reserve St Ste 402, Missoula, MT 59808 2017-07-18
1427594761 Erin Boggs Specialist/Technologist 2921 Dublin St, Missoula, MT 59808 2017-01-10
1942603287 Benjamin Cody Mcintosh Chiropractor 1070 N. Russell St., Missoula, MT 59808 2014-10-01
1518219617 Pure Medical Inc Ambulance 5515 Bonanza Place, Missoula, MT 59808 2012-10-12
1932462231 Kathleen F Calcagno Specialist/Technologist 2615 Connery Way, Suite 2b, Missoula, MT 59808 2012-06-21
1639454127 Dentyn Dunaway Pharmacist 2527 N Reserve Street, Missoula, MT 59808 2011-10-15
1750557690 Carl Thornblade, Md, Pllc Allergy & Immunology 2801 Great Northern Loop Ste 101, Missoula, MT 59808 2008-04-30
Find all providers in zip 59808

Taxonomy Information

Taxonomy Code 207XP3100X
Grouping Allopathic & Osteopathic Physicians
Classification Orthopaedic Surgery
Specialization Pediatric Orthopaedic Surgery

Taxonomy Definition

An orthopedic surgeon who has additional training and experience in diagnosing, treating and managing musculoskeletal problems in infants, children and adolescents. These may include limb and spine deformities (such as club foot, scoliosis); gait abnormalities (limping); bone and joint infections; broken bones.
Notes: Source: American Academy of Pediatrics, www.aap.org [7/1/2006: new]

Providers in the same taxonomy and city

NPI Name Taxonomy Address Enumeration
1164867370 Joseph Fox Orthopaedic Surgery 2835 Fort Missoula Rd Ste 201, Missoula, MT 59804-7424 2013-05-01

Providers in the same taxonomy and state

NPI Name Taxonomy Address Enumeration
1063683209 Joshua William Bendz Klatt Orthopaedic Surgery 1450 Ellis St, Suite 201, Bozeman, MT 59715-8812 2008-03-16

Competitor

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City MISSOULA
Zip Code 59808

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Dataset Information

Data Provider Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES)
Jurisdiction Medicare & Medicaid

This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.

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