NPIMap

Organization Active NPI

Genesis Vascular of Salt Lake

  • Interventional Cardiology Physician
  • Salt Lake City, UT
National Provider Identifier
1104361591
Registry record updated Oct 7, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Interventional Cardiology PhysicianTaxonomy code 207RI0011X
Legal business name
GENESIS VASCULAR OF SALT LAKE
Practice address
6321 S Redwood Rd
Suite 102
Salt Lake City, UT 84123-6798
Phone
(385) 388-8003
Fax
(385) 344-4006
NPI assigned
Dec 21, 2016
Organization subpart
Yes
Parent organization
GENESIS VASCULAR OF SALT LAKEAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Oct 7, 2020

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

Authorized official

Name
Dennis Munford
Title
Manager
Phone
(385) 388-8003

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Interventional Cardiology PhysicianGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 207RI0011X Primary
Vascular & Interventional Radiology PhysicianGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 2085R0204X
Vascular Surgery PhysicianGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 2086S0129X

Addresses

Primary practice location

6321 S Redwood Rd
Suite 102
Salt Lake City, UT 84123-6798

Mailing address

6321 S Redwood Rd Ste 102
Taylorsville, UT 84123-6799
Phone (385) 388-8003

Other names 1

  • Genesis Vascular of Salt Lake, LLC Doing business as

Electronic endpoints 1

TypeEndpointUseAffiliation
CONNECT URL Taylorsville Health Information Exchange (HIE)

National Provider Directory

National Provider Directory

NPI Registry JSON

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

{
    "created_epoch": "1482278400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1602028800000",
    "number": "1104361591",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6321 S REDWOOD RD STE 102",
            "city": "TAYLORSVILLE",
            "state": "UT",
            "postal_code": "841236799",
            "telephone_number": "385-388-8003",
            "fax_number": "385-344-4006"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6321 S REDWOOD RD",
            "address_2": "SUITE 102",
            "city": "SALT LAKE CITY",
            "state": "UT",
            "postal_code": "841236798",
            "telephone_number": "385-388-8003",
            "fax_number": "385-344-4006"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GENESIS VASCULAR OF SALT LAKE",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "GENESIS VASCULAR OF SALT LAKE",
        "enumeration_date": "2016-12-21",
        "last_updated": "2020-10-07",
        "certification_date": "2020-10-07",
        "status": "A",
        "authorized_official_last_name": "MUNFORD",
        "authorized_official_first_name": "DENNIS",
        "authorized_official_title_or_position": "MANAGER",
        "authorized_official_telephone_number": "385-388-8003"
    },
    "taxonomies": [
        {
            "code": "207RI0011X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Internal Medicine, Interventional Cardiology",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "2085R0204X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Radiology, Vascular & Interventional Radiology",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "2086S0129X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Surgery, Vascular Surgery",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "CONNECT",
            "endpointTypeDescription": "CONNECT URL",
            "endpoint": "Taylorsville",
            "affiliation": "N",
            "use": "HIE",
            "useDescription": "Health Information Exchange (HIE)",
            "address_1": "6321 S Redwood Rd",
            "address_2": "SUITE 102",
            "city": "Salt Lake City",
            "state": "UT",
            "country_code": "US",
            "postal_code": "841236798",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": [
        {
            "organization_name": "Genesis Vascular of Salt Lake, LLC",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Genesis Vascular of Salt Lake, LLC",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Salt Lake City, UT

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 7, 2020; 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.