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).
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 |
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 Name | Type Code |
---|---|
Missoula Bone & Joint Surgical Center | Doing Business As Name - Organization |
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 |
Street Address |
2360 MULLAN RD SUTIE C |
City | MISSOULA |
State | MT |
Zip Code | 59808-1811 |
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 |
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 Code | 207XP3100X |
Grouping | Allopathic & Osteopathic Physicians |
Classification | Orthopaedic Surgery |
Specialization | Pediatric Orthopaedic Surgery |
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] |
NPI | Name | Taxonomy | Address | Enumeration |
---|---|---|---|---|
1164867370 | Joseph Fox | Orthopaedic Surgery | 2835 Fort Missoula Rd Ste 201, Missoula, MT 59804-7424 | 2013-05-01 |
NPI | Name | Taxonomy | Address | Enumeration |
---|---|---|---|---|
1063683209 | Joshua William Bendz Klatt | Orthopaedic Surgery | 1450 Ellis St, Suite 201, Bozeman, MT 59715-8812 | 2008-03-16 |
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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.