University of Utah Healthcare
Organization Active NPI Emotionally Disturbed Childrens' Residential Treatment Facility · Salt Lake City, UT
NPI 1235546573 · NPPES record last updated Mar 3, 2017
Key facts
- NPI
- 1235546573
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Emotionally Disturbed Childrens' Residential Treatment Facility 322D00000X
- License
- 13644 (UT)
- Legal business name
- UNIVERSITY OF UTAH HEALTHCARE
- Practice address
- 51 W 3900 S
Salt Lake City, UT 84107-1431 - Phone
- (801) 587-2370
- Fax
- (801) 266-1088
- NPI assigned
- Jul 18, 2014
- Organization subpart
- No
Authorized official
- Name
- Ross Van Vranken
- Title
- Executive Director
- Phone
- (801) 587-3115
Other NPIs on the same Medicare enrollment 1
Corporate family (same tax ID) 24
Practitioners 36
-
Niki Lynn Barwick, MS CCC-A
-
Rachal Adelle Buchanan, LCSW
-
Joseph Evans Dansie, AUD
-
Johnny Downard, OT
-
Lon Forsyth, OT
-
Paul Hartman, P.T.
-
Daniel A. James, MED, LAT, ATC
-
Derrik Thomas Legler, SLP
-
Yvonne C Savarise, PT, DPT
-
Tanner Smith, FNP-C
-
Jennifer A Stamper, SLP
-
Hunter Stuercke, PT
-
Allison Yarborough, PT, DPT
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in UT
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20050629000441 | UT | Part B Supplier - Clinic/Group Practice | 0749262665 |
Receives reassigned benefits from 144 practitioners 1 other NPI on this enrollment This NPI is an additional NPI on the enrollment Practice locations: Salt Lake City, UT |
National Provider Directory
- Tax ID family
- Bruce D Etringer PHD
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Emotionally Disturbed Childrens' Residential Treatment Facility | 322D00000X | 13644 | UT | Yes |
Addresses
Primary practice location
51 W 3900 S
Salt Lake City, UT 84107-1431
Mailing address
51 W 3900 S
Salt Lake City, UT 84107-1431
Other providers in Salt Lake City, UT
- University of Utah Dept of OBGYN Urogynecology
- University of Utah Division of Pediatric Neurosurgery
- University of Utah Emergency Physicians
- University of Utah General Pediatrics
- University of Utah Health Care
- University of Utah Hospital
- University of Utah Hospital
- University of Utah Hospital
- University of Utah Hospital
- University of Utah Hospital
All providers in Salt Lake City, UT · Emotionally Disturbed Childrens' Residential Treatment Facility in Utah
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Mar 3, 2017. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.