EDWARD W GANELLEN (NPI# 1164414017) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1164414017 |
| Entity Type | Individual |
| Full Name | EDWARD W GANELLEN |
| Credential | MD |
| Practice Address |
1160 E 3900 S Suite 2000 Salt Lake City UT 84124-1202 |
| Practice Telephone | 8012663418 |
| Practice Fax Number | 8012884444 |
| Mailing Telephone | 8012663418 |
| Mailing Fax Number | 8012884444 |
| Enumeration Date | 2005-08-17 |
| Last Update Date | 2015-01-20 |
| Gender Code | M |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 207RC0000X |
Internal Medicine Specialization: Cardiovascular Disease |
187176-1205 | UT | Allopathic & Osteopathic Physicians |
| Y | 207RI0011X |
Internal Medicine Specialization: Interventional Cardiology |
187176-1205 | UT | Allopathic & Osteopathic Physicians |
| Street Address |
1160 E 3900 S SUITE 2000 |
| City | SALT LAKE CITY |
| State | UT |
| Zip Code | 84124-1202 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1962853432 | Nicholas J. Paulk Md, PC | Surgery | 1160 E 3900 S, Ste 4100, Salt Lake City, UT 84124-1202 | 2016-06-27 |
| 1174988489 | Michael Pulley | Physician Assistant | 1160 E 3900 S, Siuite 5000, Salt Lake City, UT 84124-1202 | 2015-12-31 |
| 1972972883 | Aaron Adams | Nurse Practitioner | 1160 E 3900 S, Ste 2000, Salt Lake City, UT 84124-1236 | 2015-09-21 |
| 1578962700 | Marc Waters | Physician Assistant | 1160 E 3900 S, Suite 5000, Salt Lake City, UT 84124-1202 | 2014-08-13 |
| 1538576673 | Heidi Favero | Nurse Practitioner | 1160 E 3900 S, Ste 3500, Salt Lake City, UT 84124-1202 | 2014-07-21 |
| 1255744017 | Tyler Williamson | Physician Assistant | 1160 E 3900 S, Suite 5000, Salt Lake City, UT 84124-1202 | 2014-06-09 |
| 1922342732 | St. Mark's Physician Billing, LLC | Clinic/Center | 1160 E 3900 S, Ste G200, Salt Lake City, UT 84124-1202 | 2012-11-16 |
| 1043561517 | Ashley Majoskey | Physician Assistant | 1160 E 3900 S, Ste 2000, Salt Lake City, UT 84124-1202 | 2012-09-25 |
| 1437446168 | Mountainstar Cardiology St Marks LLC | Internal Medicine | 1160 E 3900 S, Ste. 2000, Salt Lake City, UT 84124-1202 | 2011-07-01 |
| 1427372515 | Joanna Erzinger | Psychiatry & Neurology | 1160 E 3900 S, Suite 4100, Salt Lake City, UT 84124-1202 | 2010-03-18 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1487273298 | Shannon Penny Price | Social Worker | 4465 Maybeck Place, Condo C, Millcreek, UT 84124 | 2020-04-11 |
| 1922654367 | Joseph C Melvin Md PC | Colon & Rectal Surgery | 1250 East 3900 South Ste 320, Salt Lake City, UT 84124 | 2019-08-12 |
| 1366923252 | Melanie Stumpf | Counselor | 1141 E 3900, Suite A170, Salt Lake City, UT 84124 | 2018-08-28 |
| 1376033993 | Michelle Flowers | Speech-Language Pathologist | 2120 East 3900 South, Ste 200, Holladay, UT 84124 | 2018-05-18 |
| 1740797257 | Lissa Anne Hutchings | Nurse Practitioner | 1160 E 3900 S Ste 4100, Salt Lake City, UT 84124 | 2018-01-05 |
| 1316465693 | Randy Gines | Counselor | 4460 S Highland Drive # 230, Murray, UT 84124 | 2017-09-06 |
| 1417470717 | Joshua Chandler Spencer | Counselor | 4460 South Highland Dr., 230, Murray, UT 84124 | 2017-07-19 |
| 1659891554 | Marcus Whitney | Counselor | 4460 S Highland Dr. # 230, Murray, UT 84124 | 2017-06-21 |
| 1518496884 | Courtney Nilson | Counselor | 4460 S. Highland Dr. #230, Murray, UT 84124 | 2017-06-08 |
| 1841687126 | Intrafilrx | Preferred Provider Organization | 3920 S 1100 E Ste 210, Salt Lake City, UT 84124 | 2015-04-23 |
| Find all providers in zip 84124 | ||||
| Taxonomy Code | 207RI0011X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Internal Medicine |
| Specialization | Interventional Cardiology |
| An area of medicine within the subspecialty of cardiology, which uses specialized imaging and other diagnostic techniques to evaluate blood flow and pressure in the coronary arteries and chambers of the heart and uses technical procedures and medications to treat abnormalities that impair the function of the cardiovascular system. |
| Notes: Source: American Board of Medical Specialties, 2007. www.abms.org [7/1/2007: added definition, added source] Additional Resources: American Board of Internal Medicine, 2007. http://www.abim.org/ Board Certification for Medical Doctors (MDs) is provided by the American Board of Internal Medicine. ACGME Accredited Residency Program Requirements: 1 year of training plus a prerequisite of 3 years Internal Medicine, 3 years Cardiovascular Disease for a total of 7 years. ABMS Approved Subspecialty Certificate (Internal Medicine) |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1386272755 | Advanced Vein and Vascular of Salt Lake City LLC | Internal Medicine | 6321 S Redwood Rd Ste 102, Salt Lake City, UT 84123-6799 | 2020-03-31 |
| 1114361136 | Lee Anthony Linstroth | Internal Medicine | 30 N 1900 E, Room 4c104, Salt Lake City, UT 84132-0002 | 2013-04-21 |
| 1437446168 | Mountainstar Cardiology St Marks LLC | Internal Medicine | 1160 E 3900 S, Ste. 2000, Salt Lake City, UT 84124-1202 | 2011-07-01 |
| 1770720534 | Zubair Cardiovascular Inc | Internal Medicine | 82 South 1100 East, Suite 402, Salt Lake City, UT 84102 | 2009-01-15 |
| 1629221841 | Eric M Lindley | Internal Medicine | University of Utah, Salt Lake City, UT 84132-0001 | 2008-10-31 |
| 1255591194 | Vamsee Mohan Yaganti | Internal Medicine | 1160 E 3900 S Ste 2000, Salt Lake City, UT 84124-1236 | 2008-06-13 |
| 1154538148 | Anwar Tandar | Internal Medicine | 30 N 1900 E, University of Utah Hospital, Salt Lake City, UT 84132-0002 | 2007-05-17 |
| 1134219769 | William Harvey Barry | Internal Medicine | 50 N Medical Dr, Cardiology Division, Salt Lake City, UT 84132-0001 | 2006-10-13 |
| 1922058064 | Cardiovascular Consultants of Utah PC | Internal Medicine | 24 S 1100 E, Suite 304, Salt Lake City, UT 84102-1500 | 2006-05-11 |
| 1982682647 | Theophilus E Owan | Internal Medicine | 100 Mario Capecchi Dr, Salt Lake City, UT 84113-1103 | 2006-01-04 |
| Find all providers in SALT LAKE CITY | ||||
| City | SALT LAKE CITY |
| Zip Code | 84124 |
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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.