UNIVERSITY OF UTAH PEDIATRIC SERVICES (NPI# 1063876100) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1063876100 |
| Entity Type | Organization |
| Organization Name | UNIVERSITY OF UTAH PEDIATRIC SERVICES |
| Other Organization Name | PEDIATRIC OTOLARYNGOLOGY |
| Practice Address |
100 N Mario Capecchi Dr Salt Lake City UT 84113-1103 |
| Mailing Address |
Po Box 841450 Los Angeles CA 90084-1450 |
| Practice Telephone | 8015876336 |
| Mailing Telephone | 8012133900 |
| Enumeration Date | 2016-04-05 |
| Last Update Date | 2020-05-21 |
| 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 |
|---|---|---|---|---|---|
| Y | 207YP0228X |
Otolaryngology Specialization: Pediatric Otolaryngology |
Allopathic & Osteopathic Physicians |
| Other Name | Type Code |
|---|---|
| Pediatric Otolaryngology | 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 |
| 1023542388 | University of Utah Pediatric Services | Pediatrics | 2360 Mullan Rd, Sutie C, Missoula, MT 59808-1811 | 2017-04-13 |
| 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 |
| Street Address |
100 N MARIO CAPECCHI DR |
| City | SALT LAKE CITY |
| State | UT |
| Zip Code | 84113-1103 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1750346607 | Paul Krakovitz | Otolaryngology | 100 N Mario Capecchi Dr, Salt Lake City, UT 84113-1103 | 2006-04-20 |
| 1417565839 | Gabriel Dunya | Student in an Organized Health Care Education/Training Program | 100 N Mario Capecchi Dr, Salt Lake City, UT 84113-1103 | 2020-07-22 |
| 1588281000 | Alexandra Almberg | Nurse Practitioner | 100 N Mario Capecchi Dr, Salt Lake City, UT 84113-1103 | 2020-06-30 |
| 1538781224 | Adam Hine | Dentist | 100 N Mario Capecchi Dr, Salt Lake City, UT 84113-1103 | 2020-05-15 |
| 1790306488 | Leslie Goltra | Pharmacist | 100 N Mario Capecchi Dr, Salt Lake City, UT 84113-1103 | 2020-05-04 |
| 1194345512 | Perry Alana Chapman | Dietitian, Registered | 100 N Mario Capecchi Dr, Salt Lake City, UT 84113-1103 | 2020-04-26 |
| 1437779410 | Sandra Benson Johnson | Registered Nurse | 100 N Mario Capecchi Dr, Salt Lake City, UT 84113-1103 | 2020-04-20 |
| 1720608078 | Alison Mae Armstrong | Student in an Organized Health Care Education/Training Program | 100 N Mario Capecchi Dr, Salt Lake City, UT 84113-1103 | 2020-04-16 |
| 1295354850 | Katie Lynn Lahue | Music Therapist | 100 N Mario Capecchi Dr, Salt Lake City, UT 84113-1103 | 2020-04-14 |
| 1790314144 | Danielle Armstrong | Registered Nurse | 100 N Mario Capecchi Dr, Salt Lake City, UT 84113-1103 | 2020-04-07 |
| 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 | 207YP0228X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Otolaryngology |
| Specialization | Pediatric Otolaryngology |
| A pediatric otolaryngologist has special expertise in the management of infants and children with disorders that include congenital and acquired conditions involving the aerodigestive tract, nose and paranasal sinuses, the ear and other areas of the head and neck. The pediatric otolaryngologist has special skills in the diagnosis, treatment, and management of childhood disorders of voice, speech, language and hearing. |
| Notes: Source: American Board of Medical Specialties, 2007. www.abms.org [7/1/2007: definiton added, source added] Additional Resources: American Board of Otolaryngology, 2007. http://www.aboto.org/. Board certification for Medical Doctors (MDs) is provided by the American Board of Otolaryngology. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1285074617 | Melanie Duval | Otolaryngology | 100 Mario Capecchi Dr, Salt Lake City, UT 84113-1103 | 2013-06-29 |
| 1477643070 | Johannes Fredrik Grimmer | Otolaryngology | 100 N Medical Dr, Suite 4500, Salt Lake City, UT 84113-1103 | 2006-10-13 |
| 1972693596 | Albert H. Park | Otolaryngology | 100 N Medical Dr, Suite 4500, Salt Lake City, UT 84113-1103 | 2006-10-13 |
| 1255421863 | Harlan Ray Muntz | Otolaryngology | 100 N Medical Dr, Salt Lake City, UT 84113-1103 | 2006-10-13 |
| 1508875857 | University of Utah Otolaryngology Pediatrics | Otolaryngology | 100 Mario Capecchi Dr, Salt Lake City, UT 84113-1103 | 2006-08-05 |
| 1417986209 | University Ear Nose and Throat Associates | Otolaryngology | 50 N Medical Dr, Salt Lake City, UT 84132-0001 | 2006-07-02 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1134355225 | Phillip Lee Chaffin Jr. | Otolaryngology | 1055 N 300 W, Ste 401, Provo, UT 84604-3306 | 2009-06-03 |
| 1841348240 | Steven Michael Kelly | Otolaryngology | 1551 Renaissance Towne Dr, Suite 310, Bountiful, UT 84010-7667 | 2007-01-08 |
| City | SALT LAKE CITY |
| Zip Code | 84113 |
Please comment or provide details below to improve the information on UNIVERSITY OF UTAH PEDIATRIC SERVICES.
| 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.