Pediatric Cardiology Department of University of Utah

Primary specialty

Pediatric Cardiology PhysicianTaxonomy code 2080P0202X

Legal business name

PEDIATRIC CARDIOLOGY DEPARTMENT OF UNIVERSITY OF UTAH

Practice address

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

Phone

(801) 662-5400

Fax

(801) 662-5404

NPI assigned

Nov 6, 2006

Last updated

Sep 15, 2009By 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

Dr. Edward B Clark, MD

Title

Dept Chair

Phone

(801) 587-7400

Specialties & licenses 2

Addresses

Other identifiers 6

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Kiersten Densley, LCSW

  • Clinical Social Worker
  • Grand Forks, ND
  • NPI 1093652182
  NPD (past)

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

{
    "created_epoch": "1162771200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1252972800000",
    "number": "1114096195",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "295 CHIPETA WAY",
            "address_2": "U OF U SOM DEPT OF PEDIATRICS",
            "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 MARIO CAPECCHI DR",
            "city": "SALT LAKE CITY",
            "state": "UT",
            "postal_code": "841131103",
            "telephone_number": "801-662-5400",
            "fax_number": "801-662-5404"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PEDIATRIC CARDIOLOGY DEPARTMENT OF UNIVERSITY OF UTAH",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-11-06",
        "last_updated": "2009-09-15",
        "status": "A",
        "authorized_official_last_name": "CLARK",
        "authorized_official_first_name": "EDWARD",
        "authorized_official_middle_name": "B",
        "authorized_official_title_or_position": "DEPT CHAIR",
        "authorized_official_telephone_number": "801-587-7400",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "2080P0202X",
            "taxonomy_group": "",
            "desc": "Pediatrics, Pediatric Cardiology",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "121313000",
            "state": "WY"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "22001832",
            "state": "CO"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "200817950A",
            "state": "IN"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "807148600",
            "state": "ID"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "100507101",
            "state": "NV"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "200065910A",
            "state": "OK"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Pediatric Adolescent Medicine Department of Univeristy of Utah
• Pediatric Allergy
• Pediatric Anesthesiologists Inc
• Pediatric Behavioral Health
• Pediatric Bone Marrow Transplant Department of University of Utah
• Pediatric Critical Care Department of University of Utah
• Pediatric Emergency Medicine Department of University of Utah
• Pediatric Emergency Sedation Service
• Pediatric Endocrinology Department of University of Utah
• Pediatric Gastroenterology Department of University of Utah

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

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 15, 2009; 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.