NPIMap

University of Utah Pediatric Surgeons

Organization Active NPI Pediatric Surgery Physician · Salt Lake City, UT

NPI 1083623904 · NPPES record last updated Apr 14, 2009

Key facts

NPI
1083623904
Entity type
Organization (NPI type 2)
Primary specialty
Pediatric Surgery Physician 2086S0120X
Legal business name
UNIVERSITY OF UTAH PEDIATRIC SURGEONS
Practice address
100 Mario Capecchi Dr
Suite 2600
Salt Lake City, UT 84113-1103
Phone
(801) 662-2950
NPI assigned
Aug 7, 2006
Organization subpart
No

Authorized official

Name
Janell I Madonna
Title
Director of Contracting and Pe
Phone
(801) 587-6464

Practitioners 16

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

National Provider Directory

Locations

100 N Medical Dr
#2600
Salt Lake City, UT 84112
Phone (801) 588-3350

100 N Mario Capecchi Dr
Ste 2600
Salt Lake City, UT 84113
Phone (801) 662-2950

100 N Mario Capecchi Dr
#2600
Salt Lake Cty, UT 84113
Phone (801) 662-2950

Specialties & licenses

Specialty (taxonomy)CodeLicenseStatePrimary
Surgery Physician
Group: 193200000X MULTI-SPECIALTY GROUP		 208600000X
Pediatric Surgery Physician
Group: 193200000X MULTI-SPECIALTY GROUP		 2086S0120X Yes

Addresses

Primary practice location

100 Mario Capecchi Dr
Suite 2600
Salt Lake City, UT 84113-1103

Mailing address

100 Mario Capecchi Dr
Suite 2600
Salt Lake City, UT 84113-1103
Phone (801) 662-0250

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API JSON format, last updated by the provider on Apr 14, 2009.

{
    "created_epoch": "1154908800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1239667200000",
    "number": "1083623904",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "100 MARIO CAPECCHI DR",
            "address_2": "SUITE 2600",
            "city": "SALT LAKE CITY",
            "state": "UT",
            "postal_code": "841131103",
            "telephone_number": "801-662-0250"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "100 MARIO CAPECCHI DR",
            "address_2": "SUITE 2600",
            "city": "SALT LAKE CITY",
            "state": "UT",
            "postal_code": "841131103",
            "telephone_number": "801-662-2950"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "UNIVERSITY OF UTAH PEDIATRIC SURGEONS",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-08-07",
        "last_updated": "2009-04-14",
        "status": "A",
        "authorized_official_last_name": "MADONNA",
        "authorized_official_first_name": "JANELL",
        "authorized_official_middle_name": "I",
        "authorized_official_title_or_position": "DIRECTOR OF CONTRACTING AND PE",
        "authorized_official_telephone_number": "801-587-6464"
    },
    "taxonomies": [
        {
            "code": "208600000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Surgery",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "2086S0120X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Surgery, Pediatric Surgery",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Salt Lake City, UT

All providers in Salt Lake City, UT · Pediatric Surgery Physician in Utah

Sources for this page

Verify at the official NPI Registry.