UNIVERSITY OF UTAH DIVISION OF PEDIATRIC NEUROSURGERY (NPI# 1417068271) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1417068271 |
| Entity Type | Organization |
| Organization Name | UNIVERSITY OF UTAH DIVISION OF PEDIATRIC NEUROSURGERY |
| Practice Address |
100 N Medical Dr Suite 2400 Salt Lake City UT 84113-1103 |
| Mailing Address |
50 N Medical Dr 3b409-som Salt Lake City UT 84132-0001 |
| Practice Telephone | 8015883400 |
| Practice Fax Number | 8015883409 |
| Mailing Telephone | 8015816909 |
| Mailing Fax Number | 8015814385 |
| Enumeration Date | 2006-08-31 |
| Last Update Date | 2011-09-06 |
| Authorized Official Name | DR. WILLIAM T COULDWELL (DEPT CHAIR) |
| Authorized Official Telephone | 8015816909 |
| Authorized Official Credential | MD |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 2086S0120X |
Surgery Specialization: Pediatric Surgery |
Allopathic & Osteopathic Physicians | ||
| Y | 207T00000X | Neurological Surgery | Allopathic & Osteopathic Physicians |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| OK | 200019110A | 05 | |
| WA | 7123755 | 05 | |
| ID | 003073800 | 05 | |
| WY | 116059100 | 05 | |
| CO | 29584205 | 05 | |
| NV | 100501144 | 05 | |
| NM | 837253 | 05 | |
| IN | 100389310A | 05 | |
| TX | X9X042036 | 05 |
| Street Address |
100 N MEDICAL DR SUITE 2400 |
| City | SALT LAKE CITY |
| State | UT |
| Zip Code | 84113-1103 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1598763112 | Michael Wayne Boyer | Pediatrics | 100 N Medical Dr, Bmt, Salt Lake City, UT 84113-1103 | 2005-07-08 |
| 1679719215 | Kristen Haacke | Nurse Practitioner | 100 N Medical Dr, Salt Lake City, UT 84113-1103 | 2009-01-04 |
| 1508001736 | Juliann Wintch Allred | Psychiatry & Neurology | 100 N Medical Dr, Clinical Neurosciences Center, Neurology, Salt Lake City, UT 84132-0001 | 2008-12-02 |
| 1811141500 | Jennifer Grace O'donohoe | Student in an Organized Health Care Education/Training Program | 100 N Medical Dr, Salt Lake City, UT 84113-1103 | 2008-11-08 |
| 1033362264 | Erin Kristin Zinkhan | Pediatrics | 100 N Medical Dr, Residency Office, Salt Lake City, UT 84113-1103 | 2008-10-31 |
| 1962652966 | Rachael D Rich | Nurse Practitioner | 100 N Medical Dr, Salt Lake City, UT 84113-1103 | 2008-09-25 |
| 1528229101 | Julia Kelsey Gunther | Pediatrics | 100 N Medical Dr, Salt Lake City, UT 84113-1103 | 2008-06-17 |
| 1225295520 | Primary Children's Medical Center | General Acute Care Hospital | 100 N Medical Dr, Primary Children's Medical Center Pediatric Cardiology, Salt Lake City, UT 84113-1103 | 2008-05-22 |
| 1942476569 | Pediatric Behavioral Health | Pediatrics | 100 N Medical Dr, Peds Behavioral Health, Salt Lake City, UT 84113-1103 | 2008-05-03 |
| 1871769471 | Machelle Ross Bateman | Nurse Practitioner | 100 N Medical Dr, Salt Lake City, UT 84113-1103 | 2008-05-03 |
| 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 | 207T00000X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Neurological Surgery |
| A neurological surgeon provides the operative and non-operative management (i.e., prevention, diagnosis, evaluation, treatment, critical care, and rehabilitation) of disorders of the central, peripheral, and autonomic nervous systems, including their supporting structures and vascular supply; the evaluation and treatment of pathological processes which modify function or activity of the nervous system; and the operative and non-operative management of pain. A neurological surgeon treats patients with disorders of the nervous system; disorders of the brain, meninges, skull, and their blood supply, including the extracranial carotid and vertebral arteries; disorders of the pituitary gland; disorders of the spinal cord, meninges, and vertebral column, including those which may require treatment by spinal fusion or instrumentation; and disorders of the cranial and spinal nerves throughout their distribution. |
| Notes: Source: American Board of Medical Specialties, 2007. www.abms.org [7/1/2007: definiton added, source added] Additional Resources: American Board of Neurological Surgery, 2007. http://www.abns.org/. Board certification for Medical Doctors (MDs) is provided by the American Board of Neurological Surgery. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1073975660 | Robert Kim | Neurological Surgery | 175 N Medical Drive East 5th Floor, Salt Lake City, UT 84132-0001 | 2016-03-23 |
| 1689819146 | James Leo Mcgauley | Neurological Surgery | 8884 Alpen Way, Salt Lake City, UT 84121-6159 | 2008-12-11 |
| 1861645087 | Sarah Tamara Menacho | Neurological Surgery | 175 North Medical Drive East, 5th Floor, University of Utah Department of Neurosurgery, Salt Lake City, UT 84132-0001 | 2008-10-31 |
| 1437331592 | Dr Diana D Banks, LLC | Neurological Surgery | 5323 South 120 West, Suite 201, Salt Lake City, UT 84107 | 2007-11-30 |
| 1730249582 | James C Pingree | Neurological Surgery | 1220 E 3900 S Ste 4e, Salt Lake City, UT 84124-1343 | 2006-12-11 |
| 1235219130 | Richard H. Schmidt | Neurological Surgery | 175 N Medical Dr Fl 5, Salt Lake City, UT 84132-2303 | 2006-10-16 |
| 1487744090 | Joel Douglas Macdonald | Neurological Surgery | 82 S 1100 E Ste 103, Salt Lake City, UT 84102-1889 | 2006-10-13 |
| 1336239920 | Kenneth Stephen Yonemura | Neurological Surgery | 6360 S 3000 E Ste 210, Salt Lake City, UT 84121-6972 | 2006-10-13 |
| 1053320754 | Paul Gregory Amstutz | Neurological Surgery | 500s Foothill Blvd, Salt Lake City, UT 84148-0001 | 2006-08-05 |
| 1053325365 | Jodie Karen Levitt | Neurological Surgery | 1327 East 2100 South, Suite 101, Salt Lake City, UT 84105 | 2006-07-29 |
| Find all providers in SALT LAKE CITY | ||||
| City | SALT LAKE CITY |
| Zip Code | 84113 |
Please comment or provide details below to improve the information on UNIVERSITY OF UTAH DIVISION OF PEDIATRIC NEUROSURGERY.
| 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.