MIKE A BLACK (NPI# 1942716998) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1942716998 |
| Entity Type | Individual |
| Full Name | MIKE A BLACK |
| Credential | CEPS, NREMT |
| Practice Address |
4989 S State St Unit 57768 Salt Lake City UT 84157-5032 |
| Mailing Address |
Po Box 57768 Murray UT 84157-0768 |
| Practice Telephone | 9162171584 |
| Practice Fax Number | 8667221584 |
| Mailing Telephone | 9162171584 |
| Mailing Fax Number | 8667221584 |
| Enumeration Date | 2017-12-28 |
| Last Update Date | 2019-05-03 |
| Gender Code | M |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 146N00000X | Emergency Medical Technician, Basic | E1160515 | Emergency Medical Service Providers | |
| Y | 207RC0001X |
Internal Medicine Specialization: Clinical Cardiac Electrophysiology |
161255 | DC | Allopathic & Osteopathic Physicians |
| N | 246W00000X | Technician, Cardiology | 60434882 | WA | Technologists, Technicians & Other Technical Service Providers |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1326436007 | Mike Black | Physical Therapist | 12391 S 4000 W, #210, Riverton, UT 84096-7012 | 2015-01-02 |
| Street Address |
4989 S STATE ST UNIT 57768 |
| City | SALT LAKE CITY |
| State | UT |
| Zip Code | 84157-5032 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1831691393 | Sandra Lee Stoker | Nurse Practitioner | Intermountain Medical Center - Ricu, 5121 S. Cottonwood St., Bldg. 5, Level 5, Murray, UT 84157 | 2018-03-01 |
| 1447425897 | Jennifer Abigale Jurynec | Nurse Practitioner | 5121 South Cottonwood St., Murray, UT 84157 | 2008-04-28 |
| 1144415282 | Corwin Q Edwards | Internal Medicine | 5121 S Cottonwood Dr, Salt Lake City, UT 84157 | 2007-09-12 |
| 1891819843 | Warren Lewis Butterfield | Orthopaedic Surgery | 5169 South Cottonwood Street, Suite 430, Murray, UT 84157 | 2007-03-16 |
| 1033211776 | Ida Ripley | Advanced Practice Midwife | 5161 S Cottonwood St, Ste 130, Murray, UT 84157 | 2006-09-02 |
| 1245262229 | Elizabeth Demos Nicholson | Emergency Medicine | 5121 S. Cottonwood Street, Salt Lake City, UT 84157 | 2006-07-07 |
| 1154313690 | Steven M Scott | Orthopaedic Surgery | 5169 S Cottonwood St, Ste 430, Slc, UT 84157 | 2005-08-19 |
| 1619341278 | James Bokinskie II | Physical Therapist | 5121 Cottonwood Street, Murray, UT 84157 | 2015-11-19 |
| 1083917355 | John Dudley Duross | Physician Assistant | 5121 South Cottonwood Street, Murray, UT 84157 | 2010-12-08 |
| 1942501168 | John Miller | Physical Therapy Assistant | 5121 Cottonwood St, Murray, UT 84157 | 2010-11-04 |
| Find all providers in zip 84157 | ||||
| Taxonomy Code | 207RC0001X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Internal Medicine |
| Specialization | Clinical Cardiac Electrophysiology |
| A field of special interest within the subspecialty of cardiovascular disease, specialty of Internal Medicine, which involves intricate technical procedures to evaluate heart rhythms and determine appropriate treatment for them. |
| Notes: Source: American Board of Medical Specialties, 2007. www.abms.org [7/1/2007: added definition, added source; 7/1/2011: modified source] - Additional Resources: American Board of Internal Medicine, 2007. http://www.abim.org/. American Osteopathic Board of Internal Medicine, 2007. http://www.osteopathic.org/certification - Board certification for Medical Doctors (MDs) is provided by the American Board of Internal Medicine. Board certification for Doctors of Osteopathy (DOs) is provided by the American Osteopathic Board of Internal Medicine. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1851795652 | University of Utah Adult Services | Internal Medicine | 50 North Medical Drive, Salt Lake City, UT 84132 | 2014-10-22 |
| 1164842415 | Karnika Ayinapudi | Internal Medicine | 30 N 1900 E Rm 4a100, Salt Lake City, UT 84132-0002 | 2014-04-24 |
| 1992967335 | Nischala Nannapaneni | Internal Medicine | 1160 E 3900 S Ste 2000, Salt Lake City, UT 84124-1236 | 2008-06-26 |
| 1952480527 | Susan P. Etheridge | Internal Medicine | 81 N Mario Capecchi Dr, Salt Lake City, UT 84113-1125 | 2006-11-03 |
| 1518048305 | Travis Scott Wall | Internal Medicine | 50 N Medical Dr, Salt Lake City, UT 84132-0001 | 2006-10-18 |
| 1790866580 | Roger A. Freedman | Internal Medicine | 100 N Medical Dr, Salt Lake City, UT 84113-1103 | 2006-10-18 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1497078786 | Seongwook Han | Internal Medicine | 1055 N 500 W, Ste 101, Provo, UT 84604-3305 | 2010-03-01 |
| 1952569931 | Yonathan Melman | Internal Medicine | 4403 Harrison Blvd, Ste 3450, Ogden, UT 84403-3271 | 2008-05-27 |
| 1417025628 | Michael Cutler | Internal Medicine | 5169 S Cottonwood St, Ste 510, Murray, UT 84107-6767 | 2006-12-04 |
| 1366413924 | John H. Jentzer | Internal Medicine | 1380 E Medical Center Dr, Suite 1500, St George, UT 84790-2123 | 2006-01-31 |
| City | SALT LAKE CITY |
| Zip Code | 84157 |
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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.