WASATCH VASCULAR CENTER LLC (NPI# 1558905398) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1558905398 |
| Entity Type | Organization |
| Organization Name | WASATCH VASCULAR CENTER LLC |
| Practice Address |
3702 S State St Ste 103 Salt Lake City UT 84115-5096 |
| Mailing Address |
40 Valley Stream Pkwy Ste 100 Malvern PA 19355-1407 |
| Practice Telephone | 8012810027 |
| Practice Fax Number | 8012621533 |
| Mailing Telephone | 6106448900 |
| Enumeration Date | 2019-11-05 |
| Last Update Date | 2020-09-14 |
| Authorized Official Name | GREGG MILLER (AUTHORIZED OFFICIAL) |
| Authorized Official Telephone | 6106448900 |
| Authorized Official Credential | MD |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 2085R0204X |
Radiology Specialization: Vascular & Interventional Radiology |
Allopathic & Osteopathic Physicians |
| Address | Telephone Number | Fax Number |
|---|---|---|
| 3702 S State St Ste 105, Salt Lake City, UT 841155096 | 8012981300 | |
| 3702 S State St Ste 111, Salt Lake City, UT 841155078 | 8012810027 | 8012621533 |
| Street Address |
3702 S STATE ST STE 103 |
| City | SALT LAKE CITY |
| State | UT |
| Zip Code | 84115-5096 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1396344198 | Shannon Ballinger | Clinic/Center | 1470 400 W, Salt Lake City, UT 84115 | 2020-10-22 |
| 1992346704 | Anicka Inc | Clinic/Center | 3195 South Main St, Ste 260, South Salt Lake, UT 84115 | 2019-10-02 |
| 1083177505 | Vitor Gabriel Giuliani Alcantara Carioca | Specialist/Technologist | 1850 South Campus Drive, Salt Lake City, UT 84115 | 2019-04-11 |
| 1427528371 | Samuel James Leonhart | Behavior Technician | 354 East Coatsville Drive, Salt Lake City, UT 84115 | 2018-12-04 |
| 1093228645 | Eco Pharmacy LLC | Pharmacy | 3702 S State Street Suite 115, South Salt Lake City, UT 84115 | 2017-11-06 |
| 1568973055 | Eco Apothecary LLC | Pharmacy | 3701 S State Street Suite 114, South Salt Lake City, UT 84115 | 2017-10-24 |
| 1548780455 | Kelly Lund | Case Manager/Care Coordinator | 447 W. Bearcat Dr., Salt Lake City, UT 84115 | 2017-06-21 |
| 1104271238 | The Church of Philadelphia Inc. | Community/Behavioral Health | 2358 South Main Street, Salt Lake City, UT 84115 | 2016-04-26 |
| 1710368626 | Jennifer Swanhild Edwards | Counselor | 140 W 2100 S Ste 244, Salt Lake City, UT 84115 | 2015-06-16 |
| 1508247065 | John Mcguire | Health Educator | 1370 S. West Temple, Salt Lake City, UT 84115 | 2015-06-10 |
| Find all providers in zip 84115 | ||||
| Taxonomy Code | 2085R0204X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Radiology |
| Specialization | Vascular & Interventional Radiology |
| A radiologist who diagnoses and treats diseases by various radiologic imaging modalities. These include fluoroscopy, digital radiography, computed tomography, sonography and magnetic resonance imaging. |
| Notes: Source: American Board of Medical Specialties, 2007. www.abms.org [7/1/2007: definition added, source added] Additional Resources: American Board of Radiology, 2007. http://www.theabr.org/. Board certification for Medical Doctors (MDs) is provided by the American Board of Radiology. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1568965697 | Comprehensive Interventional Care Centers, Pllc | Radiology | 4624 S Holladay Blvd Ste 202, Salt Lake City, UT 84117-7168 | 2018-03-15 |
| 1356630073 | Claire Kaufman | Radiology | Medical Center 30 N 1900 E, Salt Lake City, UT 84132-0001 | 2011-04-04 |
| 1821154121 | Ryan Gene O'hara | Radiology | University of Utah Dept of Radiology, 30n. 1900e #1a071, Salt Lake City, UT 84132-6100 | 2006-12-29 |
| 1386731339 | Franklin J. Miller Jr. | Radiology | Dept Radiology University of Utah 50 N Medical Drive, 1a71, Salt Lake City, UT 84132-0001 | 2006-10-09 |
| 1972078723 | Physician Medical Group | Radiology | 4624 S Holladay Blvd Ste 202, Salt Lake City, UT 84117-7168 | 2018-10-08 |
| 1104361591 | Genesis Vascular of Salt Lake | Radiology | 6321 S Redwood Rd, Suite 102, Salt Lake City, UT 84123-6798 | 2016-12-21 |
| 1457755258 | University of Utah Adult Services | Radiology | 50 N Medical Dr, Salt Lake City, UT 84132-0001 | 2014-10-22 |
| 1184044190 | Kevin Maxwell | Radiology | 1200 E 3900 S, Salt Lake City, UT 84124-1300 | 2014-04-17 |
| 1316203797 | Jared Randall Garrett | Radiology | 30 N 1900 E Rm 1a071, Salt Lake City, UT 84132-0002 | 2012-04-10 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1679180509 | Provas of Provo | Radiology | 320 River Park Dr Ste 215, Provo, UT 84604-6065 | 2020-09-24 |
| 1831662311 | Cache Valley Vein | Radiology | 565 W 465 N Ste 130, Providence, UT 84332-4802 | 2019-01-07 |
| 1740608272 | Michael Max Adam | Radiology | 1055 N 500 W Ste 112, Provo, UT 84604-3305 | 2014-04-02 |
| 1982821690 | Edward John Sarver | Radiology | 5395 Old Post Rd, Ogden, UT 84403-4346 | 2007-04-20 |
| 1790736130 | St. George Radiology Inc. | Radiology | 1308 E 900 S, St George, UT 84790-8520 | 2006-05-12 |
| 1073170031 | Provas of Ogden, LLC | Radiology | 5974 Fashion Point Dr Ste 110, South Ogden, UT 84403-4712 | 2019-05-24 |
| 1407410244 | Provas of Salt Lake, LLC | Radiology | 909 E 9400 S, Sandy, UT 84094-5514 | 2019-04-26 |
| 1265483598 | Utah Valley Radiology Associates Inc | Radiology | 1034 N 500 W, Provo, UT 84604-3380 | 2006-05-12 |
| City | SALT LAKE CITY |
| Zip Code | 84115 |
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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.