UNIVERSITY OF UTAH PEDIATRIC SERVICES (NPI# 1336503812) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1336503812 |
| Entity Type | Organization |
| Organization Name | UNIVERSITY OF UTAH PEDIATRIC SERVICES |
| Other Organization Name | PEDIATRIC CARDIOLOGY ELECTROPHYSIOLOGY SERVICES |
| 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 | 2016-04-11 |
| Last Update Date | 2020-05-20 |
| 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 | 204R00000X | Electrodiagnostic Medicine | Allopathic & Osteopathic Physicians |
| Other Name | Type Code |
|---|---|
| Pediatric Cardiology Electrophysiology Services | 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 |
100 N MARIO CAPECCHI DR |
| City | SALT LAKE CITY |
| State | UT |
| Zip Code | 84113-1103 |
| 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 |
| Find all providers in the same location | ||||
| 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 |
| Find all providers in zip 84113 | ||||
| Taxonomy Code | 204R00000X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Electrodiagnostic Medicine |
| Electrodiagnostic medicine is the medical subspecialty that applies neurophysiologic techniques to diagnose, evaluate, and treat patients with impairments of the neurologic, neuromuscular, and/or muscular systems. Qualified physicians are trained in performing electrophysiological testing and interpretation of the test data. They require knowledge in anatomy, physiology, kinesiology, histology, and pathology of the brain, spinal cord, autonomic nerves, cranial nerves, peripheral nerves, neuromuscular junction, and muscles. They must know clinical features and treatment of diseases of the central, peripheral, and autonomic nervous systems, as well as those of neuromuscular junction and muscle. Physicians also require special knowledge about electric signal processing, including waveform analysis, electronics and instrumentation, stimulation and recording equipment, and statistics. |
| Notes: Source: American Association of Neuromuscular & Electrodiagnostic Medicine, 2011. www.aanem.org [1/1/2011: new] Additional Resources: American Board of Electrodiagnostic Medicine, 2011. www.abemexam.org |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1033627591 | Kkmmcb Medical, Pllc | Electrodiagnostic Medicine | 9980 South 300 West Suite 200, Sandy, UT 84070 | 2018-01-18 |
| City | SALT LAKE CITY |
| Zip Code | 84113 |
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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.