NPIMap

Organization Active NPI

Pediatric Emergency Sedation Service

  • Pediatric Emergency Medicine (Pediatrics) Physician
  • Salt Lake City, UT
National Provider Identifier
1245524651
Registry record updated Sep 6, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatric Emergency Medicine (Pediatrics) PhysicianTaxonomy code 2080P0204X
License
3176341205 Issued in UT
Legal business name
PEDIATRIC EMERGENCY SEDATION SERVICE
Practice address
100 Mario Capecchi Dr
Salt Lake City, UT 84113-1103
Phone
(801) 662-1234
NPI assigned
Jun 2, 2011
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Sep 6, 2011

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

Authorized official

Name
Mrs. Janell Madonna
Title
Contracting Director
Phone
(801) 587-6464

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatric Emergency Medicine (Pediatrics) PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 2080P0204X 3176341205 UT Primary

Addresses

Primary practice location

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

Mailing address

PO Box 413021
Salt Lake City, UT 84141-3021
Phone (801) 213-3900

National Provider Directory

National Provider Directory

NPI Registry JSON

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

{
    "created_epoch": "1306972800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1315267200000",
    "number": "1245524651",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 413021",
            "city": "SALT LAKE CITY",
            "state": "UT",
            "postal_code": "841413021",
            "telephone_number": "801-213-3900"
        },
        {
            "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": "801-662-1234"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PEDIATRIC EMERGENCY SEDATION SERVICE",
        "organizational_subpart": "NO",
        "enumeration_date": "2011-06-02",
        "last_updated": "2011-09-06",
        "status": "A",
        "authorized_official_last_name": "MADONNA",
        "authorized_official_first_name": "JANELL",
        "authorized_official_title_or_position": "CONTRACTING DIRECTOR",
        "authorized_official_telephone_number": "801-587-6464",
        "authorized_official_name_prefix": "Mrs."
    },
    "taxonomies": [
        {
            "code": "2080P0204X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Pediatrics, Pediatric Emergency Medicine",
            "state": "UT",
            "license": "3176341205",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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 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.