GENESIS VASCULAR OF SALT LAKE (NPI# 1104361591) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1104361591 |
| Entity Type | Organization |
| Organization Name | GENESIS VASCULAR OF SALT LAKE |
| Other Organization Name | GENESIS VASCULAR OF SALT LAKE, LLC |
| Practice Address |
6321 S Redwood Rd Suite 102 Salt Lake City UT 84123-6798 |
| Mailing Address |
6321 S Redwood Rd Ste 102 Taylorsville UT 84123-6799 |
| Practice Telephone | 3853888003 |
| Practice Fax Number | 3853444006 |
| Mailing Telephone | 3853888003 |
| Mailing Fax Number | 3853444006 |
| Enumeration Date | 2016-12-21 |
| Last Update Date | 2020-10-07 |
| Authorized Official Name | DENNIS MUNFORD (MANAGER) |
| Authorized Official Telephone | 3853888003 |
| Is Organization Subpart | Y |
| Parent Organization Name | GENESIS VASCULAR OF SALT LAKE |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 2085R0204X |
Radiology Specialization: Vascular & Interventional Radiology |
Allopathic & Osteopathic Physicians | ||
| N | 2086S0129X |
Surgery Specialization: Vascular Surgery |
Allopathic & Osteopathic Physicians | ||
| Y | 207RI0011X |
Internal Medicine Specialization: Interventional Cardiology |
Allopathic & Osteopathic Physicians |
| Other Name | Type Code |
|---|---|
| Genesis Vascular of Salt Lake, LLC | Doing Business As Name - Organization |
| Street Address |
6321 S REDWOOD RD SUITE 102 |
| City | SALT LAKE CITY |
| State | UT |
| Zip Code | 84123-6798 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1477541506 | Tanya Chesley | Physician Assistant | 6321 S Redwood Rd, Ste 201, Salt Lake City, UT 84123-6798 | 2005-10-12 |
| 1770509754 | Jordan Ridge Family Medicine Pllc | Family Medicine | 6321 S Redwood Rd, Ste 201, Salt Lake City, UT 84123-6798 | 2006-07-14 |
| 1184668659 | Mark Dale Johnson | Family Medicine | 6321 S Redwood Rd, Suite 201, Salt Lake City, UT 84123-6798 | 2006-06-15 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1679186837 | Utah Cvs Pharmacy LLC | Durable Medical Equipment & Medical Supplies | 5792 South Redwood Road, Taylorsville, UT 84123 | 2020-08-27 |
| 1164040614 | Mark E Hutchinson | Counselor | 5047 S Galleria Drive, Murray, UT 84123 | 2020-07-10 |
| 1396259321 | Utah Cvs Pharmacy LLC | Durable Medical Equipment & Medical Supplies | 4082 South Redwood Road, West Valley Road, UT 84123 | 2017-11-29 |
| 1083131890 | Kelli Mcstotts | Counselor | 5689 S. Redwood Road, Taylorsville, UT 84123 | 2017-08-23 |
| 1740706571 | Laura B Ellsworth | Case Manager/Care Coordinator | 5667 So. Redwood Road, 6b, Salt Lake City, UT 84123 | 2017-08-14 |
| 1790214120 | Integrated Autism Therapies | Behavioral Analyst | 5984 S. Susquehanna, Murray, UT 84123 | 2017-06-08 |
| 1083163885 | Michael John Flint | Counselor | 5861 South Redwood Road, #24, Taylorsville, UT 84123 | 2016-09-22 |
| 1548716236 | Andres Ramos | Licensed Psychiatric Technician | 697 West 4170 South, Murray, UT 84123 | 2016-09-01 |
| 1467807040 | Sheryl R Schindler | Counselor | 5770 South 1550 West, Bldg G, Primary Children's Counseling Center, Taylorsville, UT 84123 | 2016-05-02 |
| 1730562141 | Megan Merica Snarr | Dentist | 597 West 5300 South, Murray, UT 84123 | 2015-07-02 |
| Find all providers in zip 84123 | ||||
| Taxonomy Code | 207RI0011X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Internal Medicine |
| Specialization | Interventional Cardiology |
| An area of medicine within the subspecialty of cardiology, which uses specialized imaging and other diagnostic techniques to evaluate blood flow and pressure in the coronary arteries and chambers of the heart and uses technical procedures and medications to treat abnormalities that impair the function of the cardiovascular system. |
| Notes: Source: American Board of Medical Specialties, 2007. www.abms.org [7/1/2007: added definition, added source] Additional Resources: American Board of Internal Medicine, 2007. http://www.abim.org/ Board Certification for Medical Doctors (MDs) is provided by the American Board of Internal Medicine. ACGME Accredited Residency Program Requirements: 1 year of training plus a prerequisite of 3 years Internal Medicine, 3 years Cardiovascular Disease for a total of 7 years. ABMS Approved Subspecialty Certificate (Internal Medicine) |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1386272755 | Advanced Vein and Vascular of Salt Lake City LLC | Internal Medicine | 6321 S Redwood Rd Ste 102, Salt Lake City, UT 84123-6799 | 2020-03-31 |
| 1114361136 | Lee Anthony Linstroth | Internal Medicine | 30 N 1900 E, Room 4c104, Salt Lake City, UT 84132-0002 | 2013-04-21 |
| 1437446168 | Mountainstar Cardiology St Marks LLC | Internal Medicine | 1160 E 3900 S, Ste. 2000, Salt Lake City, UT 84124-1202 | 2011-07-01 |
| 1770720534 | Zubair Cardiovascular Inc | Internal Medicine | 82 South 1100 East, Suite 402, Salt Lake City, UT 84102 | 2009-01-15 |
| 1629221841 | Eric M Lindley | Internal Medicine | University of Utah, Salt Lake City, UT 84132-0001 | 2008-10-31 |
| 1255591194 | Vamsee Mohan Yaganti | Internal Medicine | 1160 E 3900 S Ste 2000, Salt Lake City, UT 84124-1236 | 2008-06-13 |
| 1154538148 | Anwar Tandar | Internal Medicine | 30 N 1900 E, University of Utah Hospital, Salt Lake City, UT 84132-0002 | 2007-05-17 |
| 1134219769 | William Harvey Barry | Internal Medicine | 50 N Medical Dr, Cardiology Division, Salt Lake City, UT 84132-0001 | 2006-10-13 |
| 1922058064 | Cardiovascular Consultants of Utah PC | Internal Medicine | 24 S 1100 E, Suite 304, Salt Lake City, UT 84102-1500 | 2006-05-11 |
| 1982682647 | Theophilus E Owan | Internal Medicine | 100 Mario Capecchi Dr, Salt Lake City, UT 84113-1103 | 2006-01-04 |
| Find all providers in SALT LAKE CITY | ||||
| City | SALT LAKE CITY |
| Zip Code | 84123 |
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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.