UNIVERSITY OF UTAH PEDIATRIC SERVICES


Address: 100 N Mario Capecchi Dr, Salt Lake City, UT 84113-1103
Phone: 8015876336

UNIVERSITY OF UTAH PEDIATRIC SERVICES (NPI# 1922552413) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).

Provider Overview

Nation Provider ID (NPI) 1922552413
Entity Type Organization
Organization Name UNIVERSITY OF UTAH PEDIATRIC SERVICES
Other Organization Name PEDIATRIC VASCULAR SURGERY
Practice Address 100 N Mario Capecchi Dr
Salt Lake City
UT 84113-1103
Mailing Address Po Box 841450
Los Angeles
CA 90084-1450
Practice Telephone 8015876336
Mailing Telephone 8012133900
Enumeration Date 2016-08-12
Last Update Date 2020-05-21
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

Taxonomy

Primary Taxonomy Code Classification License Number License State Taxonomy Group
N 2086S0129X Surgery
Specialization: Vascular Surgery
Allopathic & Osteopathic Physicians
Y 208000000X Pediatrics Allopathic & Osteopathic Physicians

Other Provider/Organization Names

Other Name Type Code
Pediatric Vascular Surgery Doing Business As Name - Organization

Other Provider IDs and Locations

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
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
1346692605 University of Utah Pediatric Services Pediatrics 450 E Main St, Rexburg, ID 83440-2048 2016-07-11

Office Location

Street Address 100 N MARIO CAPECCHI DR
City SALT LAKE CITY
State UT
Zip Code 84113-1103

Providers in the same location

NPI Name Taxonomy Address Enumeration
1750346607 Paul Krakovitz Otolaryngology 100 N Mario Capecchi Dr, Salt Lake City, UT 84113-1103 2006-04-20
1417565839 Gabriel Dunya Student in an Organized Health Care Education/Training Program 100 N Mario Capecchi Dr, Salt Lake City, UT 84113-1103 2020-07-22
1588281000 Alexandra Almberg Nurse Practitioner 100 N Mario Capecchi Dr, Salt Lake City, UT 84113-1103 2020-06-30
1538781224 Adam Hine Dentist 100 N Mario Capecchi Dr, Salt Lake City, UT 84113-1103 2020-05-15
1790306488 Leslie Goltra Pharmacist 100 N Mario Capecchi Dr, Salt Lake City, UT 84113-1103 2020-05-04
1194345512 Perry Alana Chapman Dietitian, Registered 100 N Mario Capecchi Dr, Salt Lake City, UT 84113-1103 2020-04-26
1437779410 Sandra Benson Johnson Registered Nurse 100 N Mario Capecchi Dr, Salt Lake City, UT 84113-1103 2020-04-20
1720608078 Alison Mae Armstrong Student in an Organized Health Care Education/Training Program 100 N Mario Capecchi Dr, Salt Lake City, UT 84113-1103 2020-04-16
1295354850 Katie Lynn Lahue Music Therapist 100 N Mario Capecchi Dr, Salt Lake City, UT 84113-1103 2020-04-14
1790314144 Danielle Armstrong Registered Nurse 100 N Mario Capecchi Dr, Salt Lake City, UT 84113-1103 2020-04-07
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Providers in the same zip code

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
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Taxonomy Information

Taxonomy Code 208000000X
Grouping Allopathic & Osteopathic Physicians
Classification Pediatrics

Taxonomy Definition

A pediatrician is concerned with the physical, emotional and social health of children from birth to young adulthood. Care encompasses a broad spectrum of health services ranging from preventive healthcare to the diagnosis and treatment of acute and chronic diseases. A pediatrician deals with biological, social and environmental influences on the developing child, and with the impact of disease and dysfunction on development.
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/certificatio
- Board certification for Medical Doctors (MDs) is provided by the American Board of Pediatrics. Board certification for Doctors of Osteopathy (DOs) is provided by the American Osteopathic Board of Pediatrics.

Providers in the same taxonomy and city

NPI Name Taxonomy Address Enumeration
1619430303 Hailey N. Baisch Pediatrics 81 N Mario Capecchi Dr Rm 1a.001, Salt Lake City, UT 84113-1125 2019-04-09
1811415565 Community Health Centers, Inc. Pediatrics 324 Tenth Ave Ste 249, Salt Lake City, UT 84103-2889 2017-09-01
1033566658 Kathryn Eleanor Curry Gradick Pediatrics University of Utah 50 North Medical Drive, Salt Lake City, UT 84132-0001 2016-05-24
1134582935 Bradley Kramer Pediatrics 1140 E 3900 S Ste 360, Salt Lake City, UT 84124-1247 2016-03-30
1831523828 Max Shaw Perelman Pediatrics 515 E 100 S, Suite 200, Salt Lake City, UT 84102-4211 2013-08-26
1780950147 Jonathan Wheatley Schmidt Pediatrics University of Utah 30 N 900 E, Salt Lake City, UT 84132-0001 2012-03-29
1942508619 Charles Elliott Richards Pediatrics 767 Sunrise Ave, Salt Lake City, UT 84103-3735 2011-03-04
1922331479 David Ray Thomas Pediatrics 2795 Casto Ln, Salt Lake City, UT 84117-6304 2009-09-16
1417101882 Scott Szucs Carleton Pediatrics 1225 3rd Ave, Salt Lake City, UT 84103-4338 2008-11-11
1063665032 Jennifer Goldman Luthy Pediatrics University Pediatric Clinic, 50 N Medical Drive, Salt Lake City, UT 84132-0001 2008-11-04
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Competitor

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City SALT LAKE CITY
Zip Code 84113

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Dataset Information

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.

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