University of Utah General Pediatrics

Primary specialty

Pediatrics PhysicianTaxonomy code 208000000X

Legal business name

UNIVERSITY OF UTAH GENERAL PEDIATRICS

Practice address

100 N Medical Dr
Salt Lake City, UT 84113-1103

Phone

(801) 588-2233

Fax

(801) 588-2236

NPI assigned

Jun 14, 2006

Last updated

Sep 6, 2011By the provider in NPPES

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Edward B Clark, MD

Title

Chair

Phone

(801) 587-7400

Specialties & licenses 1

Addresses

Other identifiers 5

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1150243200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1315267200000",
    "number": "1023051166",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "295 CHIPETA WAY",
            "address_2": "PEDS ADMIN",
            "city": "SALT LAKE CITY",
            "state": "UT",
            "postal_code": "841081220",
            "telephone_number": "801-587-7400",
            "fax_number": "801-587-7417"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "100 N MEDICAL DR",
            "city": "SALT LAKE CITY",
            "state": "UT",
            "postal_code": "841131103",
            "telephone_number": "801-588-2233",
            "fax_number": "801-588-2236"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "UNIVERSITY OF UTAH GENERAL PEDIATRICS",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-06-14",
        "last_updated": "2011-09-06",
        "status": "A",
        "authorized_official_last_name": "CLARK",
        "authorized_official_first_name": "EDWARD",
        "authorized_official_middle_name": "B",
        "authorized_official_title_or_position": "CHAIR",
        "authorized_official_telephone_number": "801-587-7400",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "122032200",
            "state": "WY"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "7116627",
            "state": "WA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "805687000",
            "state": "ID"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "100501970",
            "state": "NV"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "47157844",
            "state": "CO"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• University of Utah Department of OB-GYN
• University of Utah Dept of OBGYN Gynecologic Oncology
• University of Utah Dept of OBGYN Urogynecology
• University of Utah Division of Pediatric Neurosurgery
• University of Utah Emergency Physicians
• University of Utah Health Care
• University of Utah Healthcare
• University of Utah Hospital
• University of Utah Hospital
• University of Utah Hospital

• Pediatrics Physician in Salt Lake City, UT
• Providers in Salt Lake City, UT by specialty
• Pediatrics Physician in Utah

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 6, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.