UNIVERSITY OF UTAH OB DIAGNOSTIC CENTER (NPI# 1417983776) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1417983776 |
| Entity Type | Organization |
| Organization Name | UNIVERSITY OF UTAH OB DIAGNOSTIC CENTER |
| Practice Address |
50 N Medical Dr Salt Lake City UT 84132-0001 |
| Mailing Address |
Po Box 58859 Salt Lake City UT 84158-0859 |
| Practice Telephone | 8015812719 |
| Mailing Telephone | 8015855172 |
| Enumeration Date | 2006-06-25 |
| Last Update Date | 2008-06-30 |
| Authorized Official Name | C. MATTHEW PETERSON (DEPARTMENT CHAIR) |
| Authorized Official Telephone | 8015812719 |
| Authorized Official Credential | MD |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 2085B0100X |
Radiology Specialization: Body Imaging |
Allopathic & Osteopathic Physicians | ||
| N | 2085R0202X |
Radiology Specialization: Diagnostic Radiology |
Allopathic & Osteopathic Physicians | ||
| Y | 2085U0001X |
Radiology Specialization: Diagnostic Ultrasound |
Allopathic & Osteopathic Physicians |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| NV | NEVADA MEDICAID | 100503089 | 01 |
| WY | WYOMING MEDICAID | 117769900 | 01 |
| UT | 870410144009 | 05 | |
| ID | IDAHO MEDICAID | 003054800 | 01 |
| Street Address |
50 N MEDICAL DR |
| City | SALT LAKE CITY |
| State | UT |
| Zip Code | 84132-0001 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1477555696 | Yaw Ababio Boateng | Internal Medicine | 50 N Medical Dr, Salt Lake City, UT 84132-0100 | 2005-06-01 |
| 1073114864 | Stephanie Bevill | Registered Nurse | 50 N Medical Dr, Salt Lake City, UT 84132-0001 | 2020-11-06 |
| 1609477801 | Justin Larson | Physical Therapist | 50 N Medical Dr, Salt Lake City, UT 84132-0001 | 2020-11-04 |
| 1366042467 | Kirsty Aleah Vannoy | Occupational Therapist | 50 N Medical Dr, Salt Lake City, UT 84132-0001 | 2020-10-28 |
| 1629675673 | Erica Kueneman | Nurse Practitioner | 50 N Medical Dr, Salt Lake City, UT 84132-0001 | 2020-10-02 |
| 1487266680 | Michelle A Barker | Physical Therapist | 50 N Medical Dr, Salt Lake City, UT 84132-0001 | 2020-08-19 |
| 1770195943 | Lisa M Schaeffer | Nurse Practitioner | 50 N Medical Dr, Salt Lake City, UT 84132-0001 | 2020-08-19 |
| 1194336289 | Michelle Rios | Physical Therapist | 50 N Medical Dr, Salt Lake City, UT 84132-0001 | 2020-08-12 |
| 1932710027 | Tanner Ladsten | Physical Therapist | 50 N Medical Dr, Salt Lake City, UT 84132-0001 | 2020-08-12 |
| 1578174660 | Rachel Sette | Occupational Therapist | 50 N Medical Dr, Salt Lake City, UT 84132-0001 | 2020-08-12 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1275162331 | Scott Andrew Rizzi | Student in an Organized Health Care Education/Training Program | 30 North 1900 East Som 4c116, Salt Lake City, UT 84132 | 2020-04-02 |
| 1609421403 | Monika Fleckenstein | Ophthalmology | 65 Mario Capecchi Drive, John A. Moran Eye Center, Salt Lake City, UT 84132 | 2019-08-08 |
| 1366975914 | Jacob Brandenburg | Anesthesiology | School of Medicine 30 North 1900 East Room 3c444, Salt Lake City, UT 84132 | 2017-04-10 |
| 1568815082 | Anastasia Neufeld | Ophthalmology | 65 Mario Capecchi Drive, Salt Lake City, UT 84132 | 2016-07-20 |
| 1912350083 | Gmaan Alzhrani | Student in an Organized Health Care Education/Training Program | 175 N. Medical Drive East , Salt Lake City, UT 84132 | 2016-07-13 |
| 1831544600 | Drew Goerke | Occupational Therapist | 50 N Medical Drive, Som Room #1r73, Salt Lake City, UT 84132 | 2016-04-29 |
| 1891179024 | Bong Jik Kim | Student in an Organized Health Care Education/Training Program | 50 North Medical Drive 3c120, Otolaryngology Administration Office, Salt Lake City, UT 84132 | 2015-07-17 |
| 1043699101 | Chris Anderson | Physician Assistant | 30 North 1900 East #3c344, Salt Lake City, UT 84132 | 2015-05-22 |
| 1689061822 | Ryan Clark | Thoracic Surgery (Cardiothoracic Vascular Surgery) | 30 N 1900 E Som 3c127, Salt Lake City, UT 84132 | 2015-04-24 |
| 1649666264 | Kevin Conrad | Anesthesiology | 30 N 1900 E Room 3c444, Salt Lake City, UT 84132 | 2015-04-09 |
| Find all providers in zip 84132 | ||||
| Taxonomy Code | 2085U0001X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Radiology |
| Specialization | Diagnostic Ultrasound |
| A Radiology doctor of Osteopathy that specializes in Diagnostic Ultrasound. |
| Notes: Source: National Uniform Claim Committee, 2008 [7/1/2008: definiton added, source added] Additional Resources: The American Osteopathic Board of Radiology no longer offers a certificate in this specialty. [Note: In medical practice, Diagnostic Ultrasound is part of the scope of training and practice of a Diagnostic Radiologists – see Taxonomy Code 2085R0202X.] |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1992783682 | Portable Ultrasound of Utah LLC | Radiology | 2212 S West Temple, Ste 18, Salt Lake City, UT 84115-2642 | 2006-01-04 |
| 1558765354 | University of Utah Adult Services | Radiology | 50 N Medical Dr, Salt Lake City, UT 84132-0001 | 2014-10-22 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1265744957 | Kan Di Ki, LLC | Radiology | 3586 S 500 W, S Salt Lake, UT 84115-4236 | 2010-07-09 |
| 1609042837 | Rgl Medical Services LLC | Radiology | 1561 W 7000 S, Suite 100, West Jordan, UT 84084-3556 | 2008-05-07 |
| 1093830663 | Ihc Health Services Inc | Radiology | 170 N 1100 E, American Fork, UT 84003-2096 | 2007-03-20 |
| City | SALT LAKE CITY |
| Zip Code | 84132 |
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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.