PRIMARY CHILDREN'S MEDICAL CENTER (NPI# 1679708481) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1679708481 |
| Entity Type | Organization |
| Organization Name | PRIMARY CHILDREN'S MEDICAL CENTER |
| Practice Address |
100 No. Mario Capecchi Drive Salt Lake UT 84113 |
| Practice Telephone | 8016624980 |
| Mailing Telephone | 8016624980 |
| Enumeration Date | 2009-05-22 |
| Last Update Date | 2009-05-22 |
| Authorized Official Name | JACQLYN FITZGERALD OTTOSEN (PHYSICAL THERAPIST) |
| Authorized Official Telephone | 8015713064 |
| Authorized Official Credential | P.T. |
| Is Organization Subpart | Y |
| Parent Organization Name | INTERMOUNTAIN HEALTH CARE |
| Parent Organization TIN |
|
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 282NC2000X |
General Acute Care Hospital Specialization: Children |
120845-2401 | UT | Hospitals |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1225295520 | Primary Children's Medical Center | General Acute Care Hospital | 100 N Medical Dr, Primary Children's Medical Center Pediatric Cardiology, Salt Lake City, UT 84113-1103 | 2008-05-22 |
| 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 NO. MARIO CAPECCHI DRIVE |
| City | SALT LAKE |
| State | UT |
| Zip Code | 84113 |
| 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 |
| 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 |
| 1083864763 | Patricia Ann Jones | Nurse Practitioner | 100 No. Medical Drive, Attn Same Day Surgery, Salt Lake City, UT 84113 | 2008-09-30 |
| 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 |
| 1063748028 | Intermountain Healthcare | General Acute Care Hospital | 4401 Harrison Blvd, Newborn Intensive Care Unit, Ogden, UT 84403-3195 | 2009-10-27 |
| 1245490424 | Eric Wallace Glissmeyer | General Acute Care Hospital | 295 Chipeta Way, Salt Lake City, UT 84108-1287 | 2008-06-11 |
| 1225295520 | Primary Children's Medical Center | General Acute Care Hospital | 100 N Medical Dr, Primary Children's Medical Center Pediatric Cardiology, Salt Lake City, UT 84113-1103 | 2008-05-22 |
| 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 |
| Find all providers with the same taxonomy | ||||
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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.