Pediatric Nephrology Department Of University Of Utah

LBN: Pediatric Nephrology Department Of University Of Utah
Pediatric Nephrology Department Of University Of Utah is an health care organization with primary practice located at 100 N Medical Dr Pediatric Nephrology, Salt Lake City UT 84113-1103. The organization recently has 2 registered licenses in different health care specialties including Allopathic & Osteopathic Physicians / Pediatrics, Allopathic & Osteopathic Physicians / Pediatric Nephrology. Allopathic & Osteopathic Physicians / Pediatric Nephrology is the primary health care specialty. Pediatric Nephrology Department Of University Of Utah can be contacted via phone (801) 588-2000, or through Clark, Edward B via phone (801) 587-7400.

Contact Information

Primary practice address
100 N Medical Dr Pediatric Nephrology Salt Lake City UT 84113-1103
Phone: (801) 588-2000
Fax: (801) 587-7406
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 / Pediatric Nephrology 2080P0210X

Profile Details

NPI number 1114027968
LBN Legal business name Pediatric Nephrology Department Of University Of Utah
DBA Doing business as
Authorized official Clark, Edward B Doctor of Medicine (MD)
Entity Organization
Organization subpart 1 No
Enumeration date Sep 22nd, 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 1114027968 NPPES
Idaho MEDICAID 807147800
Idaho MEDICAID 807148700
Idaho MEDICAID 121250800
Idaho MEDICAID 100507103

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