UNIVERSITY OF UTAH PEDIATRIC SERVICES (NPI# 1346692605) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1346692605 |
| Entity Type | Organization |
| Organization Name | UNIVERSITY OF UTAH PEDIATRIC SERVICES |
| Other Organization Name | MADISON MEMORIAL HOSPITAL - PED'S CARDIOLOGY |
| Practice Address |
450 E Main St Rexburg ID 83440-2048 |
| Mailing Address |
Po Box 841450 Los Angeles CA 90084-1450 |
| Practice Telephone | 8012133599 |
| Mailing Telephone | 8012133900 |
| Enumeration Date | 2016-07-11 |
| 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 |
|---|---|---|---|---|---|
| Y | 2080P0202X |
Pediatrics Specialization: Pediatric Cardiology |
Allopathic & Osteopathic Physicians |
| Other Name | Type Code |
|---|---|
| Madison Memorial Hospital - Ped's Cardiology | 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 |
450 E MAIN ST |
| City | REXBURG |
| State | ID |
| Zip Code | 83440-2048 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1639111206 | Madison Physician Services | Emergency Medicine | 450 E Main St, Rexburg, ID 83440-2048 | 2006-06-11 |
| 1396352142 | Karissa Thueson | Nurse Practitioner | 450 E Main St, Rexburg, ID 83440-2048 | 2020-09-25 |
| 1376192674 | David Howard Anderson | Pharmacist | 450 E Main St, Rexburg, ID 83440-2048 | 2019-09-09 |
| 1124676663 | Susan B Clark | Dietitian, Registered | 450 E Main St, Rexburg, ID 83440-2048 | 2019-08-28 |
| 1790278760 | Allen Terry Miller | Pharmacist | 450 E Main St, Rexburg, ID 83440-2048 | 2018-06-13 |
| 1831682194 | Dorsie Thomas Sullenger | Pharmacist | 450 E Main St, Rexburg, ID 83440-2048 | 2018-06-12 |
| 1184122756 | Steven Craig Pierce | Physician Assistant | 450 E Main St, Rexburg, ID 83440-2048 | 2018-01-29 |
| 1215471065 | Troy Hanson | Nurse Practitioner | 450 E Main St, Rexburg, ID 83440-2048 | 2016-12-13 |
| 1871941724 | Justin Shippen | Family Medicine | 450 E Main St, Rexburg, ID 83440-2048 | 2016-06-01 |
| 1346643038 | Madison Memorial Hospital | Clinic/Center | 450 E Main St, Rexburg, ID 83440-2048 | 2014-10-08 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1235768490 | Henry's Fork Surgery Center Pllc | Clinic/Center | 23 Sawtelle Ave, Rexburg, ID 83440 | 2020-04-08 |
| 1952956906 | Shane Ellis Withers | Pharmacist | 164 E. Main, Rexburg, ID 83440 | 2019-08-06 |
| 1316392285 | Emma Anderson | Speech-Language Pathologist | 36 Professional Plaza Suite 110, Rexburg, ID 83440 | 2016-04-28 |
| 1851755524 | Sandra Frickey | Speech-Language Pathologist | 1087 Summers Drive, Premier Therapy Associates, Rexburg, ID 83440 | 2016-04-08 |
| 1275997215 | Kerry Denney | Counselor | 333 Walker Drive, Rexburg, ID 83440 | 2016-04-06 |
| 1467837583 | Wal-mart Stores, Inc. | Technician/Technologist | 303 E Moody Rd, Rexburg, ID 83440 | 2015-07-30 |
| 1649692609 | Tanabell Health Services, Inc. | Skilled Nursing Facility | 410 W 1st N, Rexburg, ID 83440 | 2014-01-10 |
| 1043652571 | Creed Simon Webster | Counselor | 30 S 2nd W, Rexburg, ID 83440 | 2013-07-25 |
| 1033461660 | James Cannon Allen Dds PC | Dentist | 106 E 1st North, Rexburg, ID 83440 | 2012-10-05 |
| 1417217316 | Shelby Dee Woolstenhulme | Speech-Language Pathologist | 450 E. Main Street, Rexburg, ID 83440 | 2012-05-24 |
| Find all providers in zip 83440 | ||||
| Taxonomy Code | 2080P0202X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Pediatrics |
| Specialization | Pediatric Cardiology |
| A pediatric cardiologist provides comprehensive care to patients with cardiovascular problems. This specialist is skilled in selecting, performing and evaluating the structural and functional assessment of the heart and blood vessels, and the clinical evaluation of cardiovascular disease. |
| 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 Pediatrics, 2007. http://www.abp.org/. American Osteopathic Board of Pediatrics, 2007. http://www.osteopathic.org/certification - Board certification for Medical Doctors (MDs) is provided by the American Board of Pediatrics. Board certification for Doctors of Osteopathy (DOs) was provided by the American Osteopathic Board of Pediatrics. The Certification is no longer offered. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1598383929 | Cristina Leon, Do Pa | Pediatrics | Idaho Falls Pediatrics, 3067 Eagle Dr, Ammon, ID 83406 | 2020-07-13 |
| 1245682509 | University of Utah Pediatric Services | Pediatrics | 98 Poplar St, Blackfoot, ID 83221-1758 | 2016-07-11 |
| 1154783017 | University of Utah Pediatric Services | Pediatrics | 777 Hospital Way, Pocatello, ID 83201-5175 | 2016-03-22 |
| 1285096149 | University of Utah Pediatric Services | Pediatrics | 2985 Cortez Ave, Idaho Falls, ID 83404-7554 | 2016-03-22 |
| 1386006245 | University of Utah Pediatric Services | Pediatrics | 3100 Channing Way, Idaho Falls, ID 83404-7533 | 2016-03-22 |
| 1982937058 | Gordon K Mack | Pediatrics | 100 E Idaho St, Suite 304, Boise, ID 83712-6267 | 2009-09-08 |
| 1891946778 | Jeremy Robert Nicolarsen | Pediatrics | 2003 Kootenai Health Way, Coeur D Alene, ID 83814-6051 | 2008-10-09 |
| 1093933830 | Robert F Adams | Pediatrics | 520 S Eagle Rd, Meridian, ID 83642-6351 | 2007-04-24 |
| 1528004702 | Diana C Alexander | Pediatrics | 190 E Bannock St, Boise, ID 83712-6241 | 2006-06-22 |
| 1760433601 | Eloisa S. Walker | Pediatrics | 100 E Idaho St, Suite 304, Boise, ID 83712-6223 | 2006-05-15 |
| Find all providers with the same taxonomy | ||||
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.