Pediatric Adolescent Medicine Department Of Univeristy Of Utah

LBN: Pediatric Adolescent Medicine Department Of Univeristy Of Utah
Pediatric Adolescent Medicine Department Of Univeristy Of Utah is an health care organization with primary practice located at 50 N Medical Dr , Salt Lake City UT 84132-0001. The organization recently has 2 registered licenses in different health care specialties including Allopathic & Osteopathic Physicians / Pediatrics, Allopathic & Osteopathic Physicians / Adolescent Medicine. Allopathic & Osteopathic Physicians / Adolescent Medicine is the primary health care specialty. Pediatric Adolescent Medicine Department Of Univeristy Of Utah can be contacted via phone (801) 581-3501, or through Clark, Edward B via phone (801) 587-7400.

Contact Information

Primary practice address
50 N Medical Dr Salt Lake City UT 84132-0001
Phone: (801) 581-3501
Fax: (801) 581-4920
Website:
Map and Directions
Authorized official contact:
Name: Clark, Edward B Doctor of Medicine (MD)
Phone: (801) 587-7400

Health care specialties

SpecialtyCodeLicense #State
Allopathic & Osteopathic Physicians / Pediatrics 208000000X
Allopathic & Osteopathic Physicians / Adolescent Medicine 2080A0000X

Profile Details

NPI number 1639123896
LBN Legal business name Pediatric Adolescent Medicine Department Of Univeristy Of Utah
DBA Doing business as
Authorized official Clark, Edward B Doctor of Medicine (MD)
Entity Organization
Organization subpart 1 No
Enumeration date May 20th, 2006
Last updated Sep 6th, 2011 - about 13 years ago

1 Some organizations, which are providing health care services, may consist of units or departments that provide different types of health care services or have several separate physical locations, where health care service is provided. These units, departments or physical locations are not themselves legal entities. However, each of them is part of the organization, which is a legal entity. The organization may decide whether its subparts, if it has any, should have their own NPI numbers. In case a subpart conducts any HIPAA standard transactions by itself, without its parent's involvement, it must have its own NPI number.

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Identifiers

StateTypeNumberIssuer
All States NPI 1639123896 NPPES
Wyoming MEDICAID 121820400
Wyoming MEDICAID 807297100
Wyoming MEDICAID 100507432

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