UNIVERSITY OF UTAH PEDIATRIC SERVICES (NPI# 1154783017) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
Nation Provider ID (NPI) | 1154783017 |
Entity Type | Organization |
Organization Name | UNIVERSITY OF UTAH PEDIATRIC SERVICES |
Other Organization Name | PORTNEUF MEDICAL CENTER - PEDIATRIC CARDIOLOGY |
Practice Address |
777 Hospital Way Pocatello ID 83201-5175 |
Mailing Address |
Po Box 841450 Los Angeles CA 90084-1450 |
Practice Telephone | 8015876336 |
Mailing Telephone | 8012133900 |
Enumeration Date | 2016-03-22 |
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 |
Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
---|---|---|---|---|---|
Y | 2080P0202X |
Pediatrics Specialization: Pediatric Cardiology |
Allopathic & Osteopathic Physicians |
Other Name | Type Code |
---|---|
Portneuf Medical Center - Pediatric Cardiology | Doing Business As Name - Organization |
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 |
1922552413 | University of Utah Pediatric Services | Surgery | 100 N Mario Capecchi Dr, Salt Lake City, UT 84113-1103 | 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 |
Street Address |
777 HOSPITAL WAY |
City | POCATELLO |
State | ID |
Zip Code | 83201-5175 |
NPI | Name | Taxonomy | Address | Enumeration |
---|---|---|---|---|
1104825892 | Gregory S Harrison | Neurological Surgery | 777 Hospital Way, Suite 115, Pocatello, ID 83201-5175 | 2005-07-15 |
1801401344 | Sunny Blue Alene Nelson | Physician Assistant | 777 Hospital Way, Pocatello, ID 83201-5175 | 2020-09-11 |
1316570757 | Mark Alan Pendleton | Nurse Anesthetist, Certified Registered | 777 Hospital Way, Pocatello, ID 83201-5175 | 2020-02-13 |
1508413220 | Hilary Worthen | Specialist/Technologist | 777 Hospital Way, Pocatello, ID 83201-5175 | 2019-08-19 |
1437612447 | Walter S Medlin Md PC | Surgery | 777 Hospital Way, Pocatello, ID 83201-5175 | 2019-04-08 |
1396203428 | Amber Frost | Family Medicine | 777 Hospital Way, Pocatello, ID 83201-5175 | 2019-03-07 |
1649756404 | Kamilla Gundersen | Nurse Practitioner | 777 Hospital Way, Pocatello, ID 83207 | 2018-07-16 |
1043716285 | Brice Anderson | Specialist/Technologist | 777 Hospital Way, Pocatello, ID 83201-5175 | 2018-04-05 |
1851808133 | Rocky Mountain Physician Group LLC | Emergency Medicine | 777 Hospital Way, Pocatello, ID 83201-5175 | 2018-01-08 |
1154838886 | Mark Willis | Nurse Practitioner | 777 Hospital Way, Pocatello, ID 83201-5175 | 2018-01-03 |
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NPI | Name | Taxonomy | Address | Enumeration |
---|---|---|---|---|
1235765330 | Timothy Palmer | Social Worker | 400 S 11th Ave, Ste 204, Pocatello, ID 83201 | 2020-03-20 |
1225687759 | Hanna Percy | Nurse Practitioner | 1151 Hospital Way Ste 201, Pocatello, ID 83201 | 2019-09-07 |
1659935195 | Carol Jane Dillon | Counselor | 707 North 7th Avenue, Suite D, Pocatello, ID 83201 | 2019-04-30 |
1154801595 | Mv Pocatello Ent, LLC | Otolaryngology | 333 N 18th Ave Ste B3, Pocatello, ID 83201 | 2018-08-15 |
1306344346 | Ruth Anne Patton | Social Worker | 850 E Young St, Pocatello, ID 83201 | 2018-01-24 |
1598289274 | Lucas Alexander Bryan | Specialist/Technologist | 1535 E Terry St, Pocatello, ID 83201 | 2017-08-03 |
1205365632 | Geno Alan Giovanini | Denturist | 115 S. 15th Ave. Ste. D, Pocatello, ID 83201 | 2017-06-08 |
1518415942 | Kelli Fries-geslin | Nurse Practitioner | 500 South 11 Ave Suite 400, Pocatello, ID 83201 | 2016-09-14 |
1346797842 | Shailyn Jenkins | Specialist/Technologist | 665 Warren Ave., Pocatello, ID 83201 | 2016-09-01 |
1992258149 | Christopher Jared White | Social Worker | 300 N 7th Ave, Pocatello, ID 83201 | 2016-07-24 |
Find all providers in zip 83201 |
Taxonomy Code | 2080P0202X |
Grouping | Allopathic & Osteopathic Physicians |
Classification | Pediatrics |
Specialization | Pediatric Cardiology |
A pediatric cardiologist provides comprehensive care to patients with cardiovascular problems. This specialist is skilled in selecting, performing and evaluating the structural and functional assessment of the heart and blood vessels, and the clinical evaluation of cardiovascular disease. |
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/certification - Board certification for Medical Doctors (MDs) is provided by the American Board of Pediatrics. Board certification for Doctors of Osteopathy (DOs) was provided by the American Osteopathic Board of Pediatrics. The Certification is no longer offered. |
NPI | Name | Taxonomy | Address | Enumeration |
---|---|---|---|---|
1598383929 | Cristina Leon, Do Pa | Pediatrics | Idaho Falls Pediatrics, 3067 Eagle Dr, Ammon, ID 83406 | 2020-07-13 |
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 |
1285096149 | University of Utah Pediatric Services | Pediatrics | 2985 Cortez Ave, Idaho Falls, ID 83404-7554 | 2016-03-22 |
1386006245 | University of Utah Pediatric Services | Pediatrics | 3100 Channing Way, Idaho Falls, ID 83404-7533 | 2016-03-22 |
1982937058 | Gordon K Mack | Pediatrics | 100 E Idaho St, Suite 304, Boise, ID 83712-6267 | 2009-09-08 |
1891946778 | Jeremy Robert Nicolarsen | Pediatrics | 2003 Kootenai Health Way, Coeur D Alene, ID 83814-6051 | 2008-10-09 |
1093933830 | Robert F Adams | Pediatrics | 520 S Eagle Rd, Meridian, ID 83642-6351 | 2007-04-24 |
1528004702 | Diana C Alexander | Pediatrics | 190 E Bannock St, Boise, ID 83712-6241 | 2006-06-22 |
1760433601 | Eloisa S. Walker | Pediatrics | 100 E Idaho St, Suite 304, Boise, ID 83712-6223 | 2006-05-15 |
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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.