UNIVERSITY OF UTAH ADULT SERVICES (NPI# 1588041131) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1588041131 |
| Entity Type | Organization |
| Organization Name | UNIVERSITY OF UTAH ADULT SERVICES |
| Other Organization Name | PORTNEUF REGIONAL MEDICAL CENTER-NEPHROLOGY |
| Practice Address |
777 Hospital Way Pocatello ID 83201-5175 |
| Mailing Address |
Po Box 841450 Los Angeles CA 90084-1450 |
| Practice Telephone | 8015812121 |
| Enumeration Date | 2015-05-04 |
| Last Update Date | 2020-05-20 |
| Authorized Official Name | ED CLARK (CHIEF MEDICAL OFFICER) |
| Authorized Official Telephone | 8015876336 |
| Is Organization Subpart | Y |
| Parent Organization Name | UNIVERSITY OF UTAH ADULT SERVICES |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 207RN0300X |
Internal Medicine Specialization: Nephrology |
Allopathic & Osteopathic Physicians |
| Other Name | Type Code |
|---|---|
| PORTNEUF REGIONAL MEDICAL CENTER-Nephrology | Doing Business As Name - Organization |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1982135984 | University of Utah Adult Services | Audiologist | 417 S Wakara Way, 1112, Salt Lake City, UT 84108-1436 | 2017-03-22 |
| 1083158257 | University of Utah Adult Services | Dentist | 375 S Chipeta Way Ste A200, Salt Lake City, UT 84108-1261 | 2016-12-07 |
| 1649724139 | University of Utah Adult Services | Dermatology | 165 N. University Ave. Farmington, Farmington, UT 84025 | 2016-08-12 |
| 1255719407 | University of Utah Adult Services | Internal Medicine | 1208 Hilltop Dr Ste 102, Rock Springs, WY 82901-5858 | 2015-05-08 |
| 1932586294 | University of Utah Adult Services | Internal Medicine | 250 South Eagle Road, Meridian, ID 83642 | 2015-05-06 |
| 1629455282 | University of Utah Adult Services | Internal Medicine | 976 Mountian City Hwy, A Plus Total Care, Elko, NV 89801-2728 | 2015-05-04 |
| 1356745137 | University of Utah Adult Services | Internal Medicine | 1950 E Circle of Hope Drive, Salt Lake City, UT 84112 | 2014-10-22 |
| 1851904247 | University of Utah Adult Services | Orthopaedic Surgery | 9385 S Snowbird Center Dr, Sandy, UT 84092-6249 | 2020-08-26 |
| 1114431921 | University of Utah Adult Services | Internal Medicine | 1950 Circle of Hope Dr, Salt Lake City, UT 84112-5500 | 2017-12-01 |
| 1174033989 | University of Utah Adult Services | Clinic/Center | 50 N Medical Dr, Salt Lake City, UT 84132-0001 | 2017-10-06 |
| 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 |
| Find all providers in the same location | ||||
| 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 | 207RN0300X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Internal Medicine |
| Specialization | Nephrology |
| An internist who treats disorders of the kidney, high blood pressure, fluid and mineral balance and dialysis of body wastes when the kidneys do not function. This specialist consults with surgeons about kidney transplantation. |
| Notes: Source: American Board of Medical Specialties, 2007. www.abms.org [7/1/2007: added definition, added source; 7/1/2011: modified source] - Additional Resources: American Board of Internal Medicine, 2007. http://www.abim.org/. American Osteopathic Board of Internal Medicine, 2007. http://www.osteopathic.org/certification - Board certification for Medical Doctors (MDs) is provided by the American Board of Internal Medicine. Board certification for Doctors of Osteopathy (DOs) is provided by the American Osteopathic Board of Internal Medicine. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1700083813 | Michael John Haderlie | Internal Medicine | 444 Hospital Way, Suite 607, Pocatello, ID 83201-2745 | 2007-07-02 |
| 1164579736 | Fahim Rahim | Internal Medicine | 444 Hospital Way, Suite 607, Pocatello, ID 83201-2701 | 2007-01-04 |
| 1013064690 | Idaho Kidney Institute LLP | Internal Medicine | 444 Hospital Way, Suite 607, Pocatello, ID 83201-2701 | 2007-01-04 |
| 1235286808 | Naeem Rahim | Internal Medicine | 444 Hospital Way, Suite 607, Pocatello, ID 83201-2701 | 2007-01-04 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1144887050 | St Michael Nephrology, Pllc | Internal Medicine | 1674 S Loggers Pond Pl Apt 14, Boise, ID 83706-7517 | 2019-05-26 |
| 1932586294 | University of Utah Adult Services | Internal Medicine | 250 South Eagle Road, Meridian, ID 83642 | 2015-05-06 |
| 1033483052 | Magic Valley Kidney Institute LLP | Internal Medicine | 350 N Haven St Ste 200, Twin Falls, ID 83301-5788 | 2012-03-08 |
| 1063719292 | St Clair Specialty Physicians | Internal Medicine | 5610 Gage Street, Suite A, Boise, ID 83706 | 2011-02-24 |
| 1558680587 | Brian Doxey Snow | Internal Medicine | 4424 E Flamingo Ave Ste 340, Nampa, ID 83687-9306 | 2010-06-01 |
| 1497931893 | Mark David Poirier | Internal Medicine | 5610 W Gage St Ste A, Boise, ID 83706 | 2008-01-15 |
| 1609952381 | Ajith J Kumar | Internal Medicine | 2124 12th Ave, Lewiston, ID 83501-3502 | 2006-10-27 |
| 1154406437 | Robert C Dobrowolski | Internal Medicine | 2131 S. Bonito Way, Meridian, ID 83642 | 2006-10-26 |
| 1235151077 | Vashu Deoomal Thakur | Internal Medicine | 166 S 5th St, Montpelier, ID 83254-1557 | 2006-07-24 |
| 1780621771 | Nicholas C Hunt I | Internal Medicine | 5610 W Gage St, Suite A, Boise, ID 83706-1349 | 2006-05-31 |
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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.