UNIVERSITY OF UTAH PEDIATRIC SERVICES (NPI# 1760928865) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1760928865 |
| Entity Type | Organization |
| Organization Name | UNIVERSITY OF UTAH PEDIATRIC SERVICES |
| Other Organization Name | PEDIATRIC EP CARDIOLOGY - POCATELLO |
| Practice Address |
110 Vista Dr Pocatello ID 83201-5824 |
| Mailing Address |
Po Box 841450 Los Angeles CA 90084-1450 |
| Practice Telephone | 2082331697 |
| Mailing Telephone | 8012133900 |
| Enumeration Date | 2017-01-12 |
| 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 |
|---|---|---|---|---|---|
| Y | 207RC0001X |
Internal Medicine Specialization: Clinical Cardiac Electrophysiology |
Allopathic & Osteopathic Physicians |
| Other Name | Type Code |
|---|---|
| Pediatric EP Cardiology - Pocatello | 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 |
| 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 |
| 1578017067 | University of Utah Pediatric Services | Pediatrics | 100 N Mario Capecchi Dr, 1, 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 |
110 VISTA DR |
| City | POCATELLO |
| State | ID |
| Zip Code | 83201-5824 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1134113251 | Mark L Mansfield | Family Medicine | 110 Vista Dr, Pocatello, ID 83201-5824 | 2005-09-02 |
| 1255808010 | Tawny Alice Spurlock | Physician Assistant | 110 Vista Dr, Pocatello, ID 83201-5824 | 2018-10-30 |
| 1467979443 | Mvh Endoscopy LLC | Clinic/Center | 110 Vista Dr, Pocatello, ID 83201-5824 | 2017-08-29 |
| 1114451804 | Mvh PC Specialists LLC | Family Medicine | 110 Vista Dr, Pocatello, ID 83201-5824 | 2017-04-19 |
| 1851839542 | Jordan Stevens | Nurse Practitioner | 110 Vista Dr, Pocatello, ID 83201-5824 | 2017-02-02 |
| 1558713131 | Jacob R Foster | Physician Assistant | 110 Vista Dr, Pocatello, ID 83201-5824 | 2016-07-07 |
| 1134477870 | Codie M Robertson | Nurse Practitioner | 110 Vista Dr, Pocatello, ID 83201-4520 | 2012-08-28 |
| 1952395063 | Richard M Maynard | Family Medicine | 110 Vista Dr, Pocatello, ID 83201-5824 | 2005-09-02 |
| 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 | 207RC0001X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Internal Medicine |
| Specialization | Clinical Cardiac Electrophysiology |
| A field of special interest within the subspecialty of cardiovascular disease, specialty of Internal Medicine, which involves intricate technical procedures to evaluate heart rhythms and determine appropriate treatment for them. |
| 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 |
|---|---|---|---|---|
| 1871190215 | Cardiovascular Specialists of America, LLC | Internal Medicine | 1515 E Clark St, Pocatello, ID 83201-4133 | 2020-10-08 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1144608308 | University of Utah Adult Services | Internal Medicine | 2985 Cortez Ave, Idaho Falls, ID 83404-7554 | 2015-05-08 |
| 1316325574 | University of Utah Adult Services | Internal Medicine | 2001 S Woodruff Ave Ste 3, Idaho Falls, ID 83404-6371 | 2015-05-08 |
| 1992182547 | University of Utah Adult Services | Internal Medicine | 3100 Channing Way, Ste 600, Idaho Falls, ID 83404-7533 | 2015-05-04 |
| 1629405857 | Western Pacemaker Clinic, Pllc | Internal Medicine | 13960 W Wainwright Dr, Boise, ID 83713-1969 | 2013-10-02 |
| 1679733414 | Joshua I Mozes | Internal Medicine | 287 W Jefferson St, Boise, ID 83702-6045 | 2008-06-16 |
| 1124236393 | Alejandro Perez-verdia | Internal Medicine | 3242 S Woodruff Ave, Idaho Falls, ID 83404-8305 | 2007-05-19 |
| 1669409785 | Melinda L. Marks | Internal Medicine | 300 E Jefferson St, Ste 101, Boise, ID 83712-6246 | 2006-06-26 |
| 1720033459 | Walter L Seale | Internal Medicine | 6140 W Curtisian, Ste 200, Boise, ID 83704 | 2006-05-23 |
| 1013961242 | Karl P Undesser | Internal Medicine | 745 S Progress Ave, Meridian, ID 83642-5619 | 2006-05-20 |
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.