UNIVERSITY OF UTAH PEDIATRIC SERVICES (NPI# 1386006245) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1386006245 |
| Entity Type | Organization |
| Organization Name | UNIVERSITY OF UTAH PEDIATRIC SERVICES |
| Other Organization Name | EASTERN IDAHO REGIONAL MEDICAL CENTER - PEDIATRIC CARDIOLOGY |
| Practice Address |
3100 Channing Way Idaho Falls ID 83404-7533 |
| Mailing Address |
Po Box 841450 Los Angeles CA 90084-1450 |
| Practice Telephone | 8015876336 |
| Mailing Telephone | 8012133900 |
| Enumeration Date | 2016-03-22 |
| 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 | EASTERN IDAHO REGIONAL MEDICAL CENTER - PEDIATRIC CARDIOLOGY |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 2080P0202X |
Pediatrics Specialization: Pediatric Cardiology |
Allopathic & Osteopathic Physicians |
| Other Name | Type Code |
|---|---|
| Eastern Idaho Regional Medical Center - Pediatric 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 |
3100 CHANNING WAY |
| City | IDAHO FALLS |
| State | ID |
| Zip Code | 83404-7533 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1851396519 | Jamie L Carter | Physician Assistant | 3100 Channing Way, Idaho Falls, ID 83404-7533 | 2005-06-17 |
| 1821697681 | Taylor Olivia Woodrow | Physician Assistant | 3100 Channing Way, Idaho Falls, ID 83404-7533 | 2020-10-22 |
| 1154944288 | Kristina Stickley | Dietitian, Registered | 3100 Channing Way, Idaho Falls, ID 83404-7533 | 2020-05-22 |
| 1487274932 | Bailey Elizabeth Kimbel | Registered Nurse | 3100 Channing Way, Idaho Falls, ID 83404-7533 | 2020-04-24 |
| 1952930109 | Chris Blaine | Student in an Organized Health Care Education/Training Program | 3100 Channing Way, Idaho Falls, ID 83404-7533 | 2020-04-08 |
| 1265061493 | Bradley Paul Roth | Student in an Organized Health Care Education/Training Program | 3100 Channing Way, Idaho Falls, ID 83404-7533 | 2020-04-08 |
| 1700415023 | Nicole Rosemin | Student in an Organized Health Care Education/Training Program | 3100 Channing Way, Idaho Falls, ID 83404-7533 | 2020-04-07 |
| 1639708027 | Victor Liu | Student in an Organized Health Care Education/Training Program | 3100 Channing Way, Idaho Falls, ID 83404 | 2020-04-07 |
| 1194354613 | Matthew James Baechle | Student in an Organized Health Care Education/Training Program | 3100 Channing Way, Idaho Falls, ID 83404-7533 | 2020-04-06 |
| 1639707961 | Dale Carlson Keller | Student in an Organized Health Care Education/Training Program | 3100 Channing Way, Idaho Falls, ID 83404-7533 | 2020-03-31 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1437750809 | Joshua M Murphy | Dentist | 1580 Elk Creek Dr., Idaho Falls, ID 83404 | 2020-11-03 |
| 1427618958 | Eastern Idaho Endodontics | Dentist | 3335 S. Holmes Ave, Idaho Falls, ID 83404 | 2019-06-17 |
| 1942863600 | Muhammad Arslan Khan | Student in an Organized Health Care Education/Training Program | 2860 Channing Way Suite 214, Idaho Falls, ID 83404 | 2019-04-18 |
| 1942771043 | Physician's Choice Cardiology, Pllc | Internal Medicine | 3302 Valencia, Suite 201, Idaho Falls, ID 83404 | 2018-12-16 |
| 1609358761 | Cardiac Cath Lab of Idaho Falls | Internal Medicine | 3311 Valencia Drive, Idaho Falls, ID 83404 | 2018-09-05 |
| 1083196380 | Hannah Golden | Occupational Therapist | 1460 Elk Creek, Idaho Falls, ID 83404 | 2018-09-04 |
| 1316423049 | Lindsay Sessions | Speech-Language Pathologist | 2210 Niagara St, Idaho Falls, ID 83404 | 2018-07-16 |
| 1720574023 | Bmh, Inc. | Anesthesiology | 3302 Valencia Dr., Suite 201, Idaho Falls, ID 83404 | 2018-07-10 |
| 1093237935 | Jason Earl Bailey | Contractor | 3100 S Woodruff Ave., Idaho Falls, ID 83404 | 2017-07-12 |
| 1235682121 | Mountain Falls Quick Care | Clinic/Center | 1995 E 17th St #1, Idaho Falls, ID 83404 | 2016-07-27 |
| Find all providers in zip 83404 | ||||
| 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 |
|---|---|---|---|---|
| 1285096149 | University of Utah Pediatric Services | Pediatrics | 2985 Cortez Ave, Idaho Falls, ID 83404-7554 | 2016-03-22 |
| 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 |
| 1346692605 | University of Utah Pediatric Services | Pediatrics | 450 E Main St, Rexburg, ID 83440-2048 | 2016-07-11 |
| 1154783017 | University of Utah Pediatric Services | Pediatrics | 777 Hospital Way, Pocatello, ID 83201-5175 | 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 |
| 1013984517 | Frederick K Emge | Pediatrics | 100 E Idaho St, Suite 200, Boise, ID 83712-6267 | 2006-03-02 |
| Find all providers with the same taxonomy | ||||
| City | IDAHO FALLS |
| Zip Code | 83404 |
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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.