UNIVERSITY OF UTAH PEDIATRIC SERVICES (NPI# 1578017067) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1578017067 |
| Entity Type | Organization |
| Organization Name | UNIVERSITY OF UTAH PEDIATRIC SERVICES |
| Other Organization Name | UDAC DIVISION |
| Practice Address |
100 N Mario Capecchi Dr 1 Salt Lake City UT 84113-1103 |
| Mailing Address |
Po Box 841450 Los Angeles CA 90084-1450 |
| Practice Telephone | 8015876336 |
| Mailing Telephone | 8012133900 |
| Enumeration Date | 2016-08-12 |
| 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 |
|---|---|---|---|---|---|
| N | 2080P0006X |
Pediatrics Specialization: Developmental – Behavioral Pediatrics |
Allopathic & Osteopathic Physicians | ||
| Y | 208000000X | Pediatrics | Allopathic & Osteopathic Physicians |
| Other Name | Type Code |
|---|---|
| UDAC Division | 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 |
| 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 |
| 1346692605 | University of Utah Pediatric Services | Pediatrics | 450 E Main St, Rexburg, ID 83440-2048 | 2016-07-11 |
| Street Address |
100 N MARIO CAPECCHI DR 1 |
| 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 | 208000000X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Pediatrics |
| A pediatrician is concerned with the physical, emotional and social health of children from birth to young adulthood. Care encompasses a broad spectrum of health services ranging from preventive healthcare to the diagnosis and treatment of acute and chronic diseases. A pediatrician deals with biological, social and environmental influences on the developing child, and with the impact of disease and dysfunction on development. |
| 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/certificatio - Board certification for Medical Doctors (MDs) is provided by the American Board of Pediatrics. Board certification for Doctors of Osteopathy (DOs) is provided by the American Osteopathic Board of Pediatrics. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1619430303 | Hailey N. Baisch | Pediatrics | 81 N Mario Capecchi Dr Rm 1a.001, Salt Lake City, UT 84113-1125 | 2019-04-09 |
| 1811415565 | Community Health Centers, Inc. | Pediatrics | 324 Tenth Ave Ste 249, Salt Lake City, UT 84103-2889 | 2017-09-01 |
| 1033566658 | Kathryn Eleanor Curry Gradick | Pediatrics | University of Utah 50 North Medical Drive, Salt Lake City, UT 84132-0001 | 2016-05-24 |
| 1134582935 | Bradley Kramer | Pediatrics | 1140 E 3900 S Ste 360, Salt Lake City, UT 84124-1247 | 2016-03-30 |
| 1831523828 | Max Shaw Perelman | Pediatrics | 515 E 100 S, Suite 200, Salt Lake City, UT 84102-4211 | 2013-08-26 |
| 1780950147 | Jonathan Wheatley Schmidt | Pediatrics | University of Utah 30 N 900 E, Salt Lake City, UT 84132-0001 | 2012-03-29 |
| 1942508619 | Charles Elliott Richards | Pediatrics | 767 Sunrise Ave, Salt Lake City, UT 84103-3735 | 2011-03-04 |
| 1922331479 | David Ray Thomas | Pediatrics | 2795 Casto Ln, Salt Lake City, UT 84117-6304 | 2009-09-16 |
| 1417101882 | Scott Szucs Carleton | Pediatrics | 1225 3rd Ave, Salt Lake City, UT 84103-4338 | 2008-11-11 |
| 1063665032 | Jennifer Goldman Luthy | Pediatrics | University Pediatric Clinic, 50 N Medical Drive, Salt Lake City, UT 84132-0001 | 2008-11-04 |
| 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 PEDIATRIC SERVICES.
| 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.