DR. CONSTANCE K MAVES (NPI# 1063513596) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1063513596 |
| Entity Type | Individual |
| Full Name | DR. CONSTANCE K MAVES |
| Credential | MD |
| Practice Address |
100 N Medical Dr Salt Lake City UT 84113-1103 |
| Mailing Address |
869 E 4500 S Pmb 511 Salt Lake City UT 84107-3049 |
| Practice Telephone | 8016621900 |
| Practice Fax Number | 8016621810 |
| Mailing Telephone | 8014870451 |
| Mailing Fax Number | 8014872467 |
| Enumeration Date | 2006-09-26 |
| Last Update Date | 2008-06-17 |
| Gender Code | F |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 2085P0229X |
Radiology Specialization: Pediatric Radiology |
5010881-1205 | UT | Allopathic & Osteopathic Physicians |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| UT | SELECTHEALTH | 1070011544101 | 01 |
| UT | EDUCATORS MUTUAL | 870355724MAV | 01 |
| UT | UNITED HEALTHCARE | 1600468 | 01 |
| UT | AETNA | 8550895 | 01 |
| UT | UUHN | 31853 | 01 |
| UT | ALTIUS | QM0000027099 | 01 |
| UT | BLUE SHIELD | 50108811200001 | 01 |
| UT | DESERET MUTUAL | 35834 | 01 |
| UT | PUBLIC EMPLOYEES HEALTH | 67154 | 01 |
| Street Address |
100 N MEDICAL DR |
| City | SALT LAKE CITY |
| State | UT |
| Zip Code | 84113-1103 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1598763112 | Michael Wayne Boyer | Pediatrics | 100 N Medical Dr, Bmt, Salt Lake City, UT 84113-1103 | 2005-07-08 |
| 1679719215 | Kristen Haacke | Nurse Practitioner | 100 N Medical Dr, Salt Lake City, UT 84113-1103 | 2009-01-04 |
| 1508001736 | Juliann Wintch Allred | Psychiatry & Neurology | 100 N Medical Dr, Clinical Neurosciences Center, Neurology, Salt Lake City, UT 84132-0001 | 2008-12-02 |
| 1811141500 | Jennifer Grace O'donohoe | Student in an Organized Health Care Education/Training Program | 100 N Medical Dr, Salt Lake City, UT 84113-1103 | 2008-11-08 |
| 1033362264 | Erin Kristin Zinkhan | Pediatrics | 100 N Medical Dr, Residency Office, Salt Lake City, UT 84113-1103 | 2008-10-31 |
| 1962652966 | Rachael D Rich | Nurse Practitioner | 100 N Medical Dr, Salt Lake City, UT 84113-1103 | 2008-09-25 |
| 1528229101 | Julia Kelsey Gunther | Pediatrics | 100 N Medical Dr, Salt Lake City, UT 84113-1103 | 2008-06-17 |
| 1225295520 | Primary Children's Medical Center | General Acute Care Hospital | 100 N Medical Dr, Primary Children's Medical Center Pediatric Cardiology, Salt Lake City, UT 84113-1103 | 2008-05-22 |
| 1942476569 | Pediatric Behavioral Health | Pediatrics | 100 N Medical Dr, Peds Behavioral Health, Salt Lake City, UT 84113-1103 | 2008-05-03 |
| 1871769471 | Machelle Ross Bateman | Nurse Practitioner | 100 N Medical Dr, Salt Lake City, UT 84113-1103 | 2008-05-03 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1386111060 | Melissa Marie Dixon | Psychologist | Primary Children's Hospital Outpatient Services, 81 South Mario Capecchi Drive, Salt Lake City, UT 84113 | 2018-10-31 |
| 1366965618 | Ashley Stuart | Psychologist | 44 North Mario Capecchi Drive, Salt Lake City, UT 84113 | 2017-07-19 |
| 1487945135 | Justin C Wheeler | Pediatrics | 81 N Mario Capecchi Dr Fl 4, Salt Lake City, UT 84113 | 2011-04-29 |
| 1154612117 | Dana Boucek | Pediatrics | 100 North Mario Capecchi Dr., Primary Children's, Salt Lake City, UT 84113 | 2011-04-26 |
| 1285959502 | Anna Katherine Eyre Ermarth | Pediatrics | 81 Mario Capecchi, Salt Lake City, UT 84113 | 2010-03-30 |
| 1457682072 | Elizabeth K Cho | Nurse Practitioner | 100 North Mario Cappechi Dr., Salt Lake City, UT 84113 | 2010-01-21 |
| 1528290848 | Nancy Crandell Brown | Nurse Practitioner | 100 North Mario Cappechi Drive, Salt Lake City, UT 84113 | 2009-08-20 |
| 1679708481 | Primary Children's Medical Center | General Acute Care Hospital | 100 No. Mario Capecchi Drive, Salt Lake, UT 84113 | 2009-05-22 |
| 1467697235 | Tara Hook | Physical Therapist | 100 North Mario Capecchi Dr, Salt Lake City, UT 84113 | 2008-12-09 |
| 1144474768 | Jennifer K Workman | Pediatrics | 100 N Mario Capecchi Drive, Pediatric Crtical Care, Primary Children's Hospital, Salt Lake City, UT 84113 | 2008-11-10 |
| Find all providers in zip 84113 | ||||
| Taxonomy Code | 2085P0229X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Radiology |
| Specialization | Pediatric Radiology |
| A radiologist who is proficient in all forms of diagnostic imaging as it pertains to the treatment of diseases in the newborn, infant, child and adolescent. This specialist has knowledge of both imaging and interventional procedures related to the care and management of diseases of children. A pediatric radiologist must be highly knowledgeable of all organ systems as they relate to growth and development, congenital malformations, diseases peculiar to infants and children and diseases that begin in childhood but cause substantial residual impairment in adulthood. |
| Notes: Source: American Board of Medical Specialties, 2007. www.abms.org [7/1/2007: definition added, source added; 7/1/2011: modified source] - Additional Resources: American Board of Radiology, 2007. http://www.theabr.org/. American Osteopathic Board of Radiology, 2007. http://www.osteopathic.org/certification - Board certification for Medical Doctors (MDs) is provided by the American Board of Radiology. Board certification for Doctors of Osteopathy (DOs) is provided by the American Osteopathic Board of Radiology. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1720198716 | William D. Winters | Radiology | 100 No Mario Capecchi Dr., Salt Lake City, UT 84113 | 2006-08-30 |
| 1215940465 | Karin L. Hoeg | Radiology | 100 No. Mario Capecchi Dr., Salt Lake City, UT 84113 | 2006-08-15 |
| 1053664680 | Ihc Health Services Inc | Radiology | 100 Mario Capecchi Dr, Salt Lake City, UT 84113-1103 | 2012-10-19 |
| 1730394131 | Ryan W. Arnold | Radiology | 100 Mario Capecchi Dr, Salt Lake City, UT 84113-1103 | 2007-05-11 |
| 1083739270 | Henry J Baskin Jr. | Radiology | 100 Mario Capecchi Dr, Salt Lake City, UT 84113-1103 | 2007-03-20 |
| 1790875300 | Kathleen Ann Murray | Radiology | Fairfax Road At Virginia Street, Shriners Hosptials for Children, Salt Lake City, UT 84103-4399 | 2006-10-13 |
| 1447351978 | Giosue Peter Feola | Radiology | 100 N Medical Dr, Salt Lake City, UT 84113-1103 | 2006-09-26 |
| 1154422681 | Gary L Hedlund | Radiology | 100 N Medical Dr, Salt Lake City, UT 84113-1103 | 2006-09-26 |
| 1306940739 | Kevin R Moore | Radiology | 100 N Medical Dr, Salt Lake City, UT 84113-1103 | 2006-09-07 |
| 1861502254 | Pediatric Radiology, P.C. | Radiology | 100 N Medical Dr, Salt Lake City, UT 84113-1103 | 2006-08-30 |
| Find all providers in SALT LAKE CITY | ||||
| City | SALT LAKE CITY |
| Zip Code | 84113 |
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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.