MOUNTAINSTAR CARDIOVASCULAR SERVICES LLC (NPI# 1689721219) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1689721219 |
| Entity Type | Organization |
| Organization Name | MOUNTAINSTAR CARDIOVASCULAR SERVICES LLC |
| Other Organization Name | MOUNTAINSTAR CARDIOVASCULAR SURGERY |
| Practice Address |
1160 E 3900 S Suite 3500 Salt Lake City UT 84124-1202 |
| Mailing Address |
2000 Health Park Dr Brentwood TN 37027-4525 |
| Practice Telephone | 8017434750 |
| Practice Fax Number | 8017434765 |
| Mailing Telephone | 6153737600 |
| Mailing Fax Number | 8663461426 |
| Enumeration Date | 2007-01-04 |
| Last Update Date | 2020-10-30 |
| Authorized Official Name | WILLIAM TEDRICK JOHNSON (GROUP VP/AO) |
| Authorized Official Telephone | 6153723375 |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 208G00000X | Thoracic Surgery (Cardiothoracic Vascular Surgery) | Allopathic & Osteopathic Physicians |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| UT | 1689721219 | 05 |
| Other Name | Type Code |
|---|---|
| MountainStar Cardiovascular Surgery | Doing Business As Name - Organization |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1093996167 | Mountainstar Cardiovascular Services LLC | Thoracic Surgery (Cardiothoracic Vascular Surgery) | 698 W 800 N, Suite #210, Orem, UT 84057-3658 | 2007-11-16 |
| 1639350705 | Mountainstar Cardiovascular Services LLC | Thoracic Surgery (Cardiothoracic Vascular Surgery) | 425 E 5350 S, Suite #350, Ogden, UT 84405-6946 | 2007-11-16 |
| Street Address |
1160 E 3900 S SUITE 3500 |
| City | SALT LAKE CITY |
| State | UT |
| Zip Code | 84124-1202 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1164414017 | Edward W Ganellen | Internal Medicine | 1160 E 3900 S, Suite 2000, Salt Lake City, UT 84124-1202 | 2005-08-17 |
| 1962853432 | Nicholas J. Paulk Md, PC | Surgery | 1160 E 3900 S, Ste 4100, Salt Lake City, UT 84124-1202 | 2016-06-27 |
| 1174988489 | Michael Pulley | Physician Assistant | 1160 E 3900 S, Siuite 5000, Salt Lake City, UT 84124-1202 | 2015-12-31 |
| 1972972883 | Aaron Adams | Nurse Practitioner | 1160 E 3900 S, Ste 2000, Salt Lake City, UT 84124-1236 | 2015-09-21 |
| 1578962700 | Marc Waters | Physician Assistant | 1160 E 3900 S, Suite 5000, Salt Lake City, UT 84124-1202 | 2014-08-13 |
| 1538576673 | Heidi Favero | Nurse Practitioner | 1160 E 3900 S, Ste 3500, Salt Lake City, UT 84124-1202 | 2014-07-21 |
| 1255744017 | Tyler Williamson | Physician Assistant | 1160 E 3900 S, Suite 5000, Salt Lake City, UT 84124-1202 | 2014-06-09 |
| 1922342732 | St. Mark's Physician Billing, LLC | Clinic/Center | 1160 E 3900 S, Ste G200, Salt Lake City, UT 84124-1202 | 2012-11-16 |
| 1043561517 | Ashley Majoskey | Physician Assistant | 1160 E 3900 S, Ste 2000, Salt Lake City, UT 84124-1202 | 2012-09-25 |
| 1437446168 | Mountainstar Cardiology St Marks LLC | Internal Medicine | 1160 E 3900 S, Ste. 2000, Salt Lake City, UT 84124-1202 | 2011-07-01 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1487273298 | Shannon Penny Price | Social Worker | 4465 Maybeck Place, Condo C, Millcreek, UT 84124 | 2020-04-11 |
| 1922654367 | Joseph C Melvin Md PC | Colon & Rectal Surgery | 1250 East 3900 South Ste 320, Salt Lake City, UT 84124 | 2019-08-12 |
| 1366923252 | Melanie Stumpf | Counselor | 1141 E 3900, Suite A170, Salt Lake City, UT 84124 | 2018-08-28 |
| 1376033993 | Michelle Flowers | Speech-Language Pathologist | 2120 East 3900 South, Ste 200, Holladay, UT 84124 | 2018-05-18 |
| 1740797257 | Lissa Anne Hutchings | Nurse Practitioner | 1160 E 3900 S Ste 4100, Salt Lake City, UT 84124 | 2018-01-05 |
| 1316465693 | Randy Gines | Counselor | 4460 S Highland Drive # 230, Murray, UT 84124 | 2017-09-06 |
| 1417470717 | Joshua Chandler Spencer | Counselor | 4460 South Highland Dr., 230, Murray, UT 84124 | 2017-07-19 |
| 1659891554 | Marcus Whitney | Counselor | 4460 S Highland Dr. # 230, Murray, UT 84124 | 2017-06-21 |
| 1518496884 | Courtney Nilson | Counselor | 4460 S. Highland Dr. #230, Murray, UT 84124 | 2017-06-08 |
| 1841687126 | Intrafilrx | Preferred Provider Organization | 3920 S 1100 E Ste 210, Salt Lake City, UT 84124 | 2015-04-23 |
| Find all providers in zip 84124 | ||||
| Taxonomy Code | 208G00000X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Thoracic Surgery (Cardiothoracic Vascular Surgery) |
| A thoracic surgeon provides the operative, perioperative and critical care of patients with pathologic conditions within the chest. Included is the surgical care of coronary artery disease, cancers of the lung, esophagus and chest wall, abnormalities of the trachea, abnormalities of the great vessels and heart valves, congenital anomalies, tumors of the mediastinum and diseases of the diaphragm. The management of the airway and injuries of the chest is within the scope of the specialty. |
| Notes: Source: American Board of Medical Specialties, 2007. www.abms.org [7/1/2007: definition added, source added] Additional Resources: American Board of Thoracic Surgery, 2007. http://www.abts.org/. Board certification for Medical Doctors (MDs) is provided by the American Board of Thoracic Surgery. Thoracic surgeons have the knowledge, experience and technical skills to accurately diagnose, operate upon safely, and effectively manage patients with thoracic diseases of the chest. This requires substantial knowledge of cardiorespiratory physiology and oncology, as well as capability in the use of heart assist devices, management of abnormal heart rhythms and drainage of the chest cavity, respiratory support systems, endoscopy and invasive and noninvasive diagnostic techniques. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1609319722 | Antigoni Koliopoulou | Thoracic Surgery (Cardiothoracic Vascular Surgery) | 30 N 1900 E # Som3c127, Salt Lake City, UT 84132-0002 | 2016-11-21 |
| 1689061822 | Ryan Clark | Thoracic Surgery (Cardiothoracic Vascular Surgery) | 30 N 1900 E Som 3c127, Salt Lake City, UT 84132 | 2015-04-24 |
| 1487994562 | Edwin Clifford Mcgough | Thoracic Surgery (Cardiothoracic Vascular Surgery) | 705 N Pioneer Fork Rd, Salt Lake City, UT 84108-1642 | 2013-02-26 |
| 1659630572 | John David Vossler | Thoracic Surgery (Cardiothoracic Vascular Surgery) | 30 N 1900 E # 3c127, Salt Lake City, UT 84132-0002 | 2012-05-12 |
| 1407145535 | Utl Solutions, Inc. | Thoracic Surgery (Cardiothoracic Vascular Surgery) | 369 E 900 S, Suite 279, Salt Lake City, UT 84111-4331 | 2011-03-29 |
| 1003063934 | Clynn Roberts Ford | Thoracic Surgery (Cardiothoracic Vascular Surgery) | 2843 Lancaster Dr, Salt Lake City, UT 84108-2535 | 2008-08-21 |
| 1356335970 | J Kent Thorne | Thoracic Surgery (Cardiothoracic Vascular Surgery) | 1160 E. 3900 S, #3500, Salt Lake City, UT 84124 | 2005-09-09 |
| 1255795308 | University of Utah Pediatric Services | Thoracic Surgery (Cardiothoracic Vascular Surgery) | 81 N Mario Capecchi Dr, Salt Lake City, UT 84113-1125 | 2016-04-05 |
| 1184028995 | University of Utah Adult Services | Thoracic Surgery (Cardiothoracic Vascular Surgery) | 50 N Medical Dr, Salt Lake City, UT 84132-0001 | 2014-10-22 |
| 1073871042 | Ashley Eleen Morgan | Thoracic Surgery (Cardiothoracic Vascular Surgery) | 30 N 1900 E, Salt Lake City, UT 84132-0002 | 2012-04-27 |
| Find all providers in SALT LAKE CITY | ||||
| City | SALT LAKE CITY |
| Zip Code | 84124 |
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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.