PRIMARY CHILDREN'S MEDICAL CENTER (NPI# 1225295520) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1225295520 |
| Entity Type | Organization |
| Organization Name | PRIMARY CHILDREN'S MEDICAL CENTER |
| Practice Address |
100 N Medical Dr Primary Children's Medical Center Pediatric Cardiology Salt Lake City UT 84113-1103 |
| Practice Telephone | 8106625400 |
| Practice Fax Number | 8016625404 |
| Mailing Telephone | 8016625400 |
| Mailing Fax Number | 8016625404 |
| Enumeration Date | 2008-05-22 |
| Last Update Date | 2008-05-22 |
| Authorized Official Name | DR. EDWARD CLARK (CHAIR OF PEDIATRICS) |
| Authorized Official Telephone | 8106621000 |
| Authorized Official Credential | M.D. |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 282NC2000X |
General Acute Care Hospital Specialization: Children |
6138575-1204 | UT | Hospitals |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1679708481 | Primary Children's Medical Center | General Acute Care Hospital | 100 No. Mario Capecchi Drive, Salt Lake, UT 84113 | 2009-05-22 |
| 1710162755 | Primary Children's Medical Center | General Acute Care Hospital | 100 N Medical Dr, Salt Lake City, UT 84113-1103 | 2008-01-09 |
| Street Address |
100 N MEDICAL DR PRIMARY CHILDREN'S MEDICAL CENTER PEDIATRIC CARDIOLOGY |
| 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 |
| 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 |
| 1023283736 | Debra Ann Templin | Nurse Practitioner | 100 N Medical Dr, Salt Lake City, UT 84113-1103 | 2008-04-23 |
| 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 | 282NC2000X |
| Grouping | Hospitals |
| Classification | General Acute Care Hospital |
| Specialization | Children |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1144408675 | Intermountain Health Care | General Acute Care Hospital | 3159 Eagle Rock Way, Salt Lake City, UT 84120-1424 | 2008-02-06 |
| 1255461075 | Shriners Hospitals for Children | General Acute Care Hospital | 1275 Fairfax Rd, Salt Lake City, UT 84103-4324 | 2007-03-07 |
| 1790230860 | Intermountain Healthcare | General Acute Care Hospital | 100 N Mario Capecchi Dr, Salt Lake City, UT 84113-1103 | 2016-08-18 |
| 1376837203 | Intermountain Healthcare | General Acute Care Hospital | 100 Mario Capecchi Dr, Salt Lake City, UT 84113-1103 | 2011-06-08 |
| 1245490424 | Eric Wallace Glissmeyer | General Acute Care Hospital | 295 Chipeta Way, Salt Lake City, UT 84108-1287 | 2008-06-11 |
| 1861660268 | Intermountain Health Care | General Acute Care Hospital | 100 N Medical Dr, Salt Lake City, UT 84113-1103 | 2008-02-19 |
| 1154508653 | Intermountain Healthcare | General Acute Care Hospital | 100 N Medical Dr, Pcmc, Salt Lake City, UT 84113-1103 | 2008-01-28 |
| 1710162755 | Primary Children's Medical Center | General Acute Care Hospital | 100 N Medical Dr, Salt Lake City, UT 84113-1103 | 2008-01-09 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1679708481 | Primary Children's Medical Center | General Acute Care Hospital | 100 No. Mario Capecchi Drive, Salt Lake, UT 84113 | 2009-05-22 |
| 1063748028 | Intermountain Healthcare | General Acute Care Hospital | 4401 Harrison Blvd, Newborn Intensive Care Unit, Ogden, UT 84403-3195 | 2009-10-27 |
| City | SALT LAKE CITY |
| Zip Code | 84113 |
Please comment or provide details below to improve the information on PRIMARY CHILDREN'S MEDICAL CENTER.
| 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.