Individual provider Active NPI

Kathleen Lawliss, MD

  • Emergency Medicine Physician
  • Salt Lake City, UT
National Provider Identifier
1255397691
Registry record updated May 4, 2010
On this page

Key facts

NPPES NPI Registry
Primary specialty
Emergency Medicine PhysicianTaxonomy code 207P00000X
License
374573-1205 Issued in UT
Practice address
1200 E 3900 S
Salt Lake City, UT 84124-1300
Phone
(801) 268-7975
NPI assigned
Apr 25, 2006
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on May 4, 2010

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Emergency Medical Services (Emergency Medicine) Physician 207PE0004X 374573-1205 UT
Emergency Medicine Physician 207P00000X 374573-1205 UT Primary

Addresses

Primary practice location

1200 E 3900 S
Salt Lake City, UT 84124-1300

Mailing address

144 S 500 E
2ND Floor
Salt Lake City, UT 84102-1907

Other identifiers 1

IdentifierTypeStateIssuer
D3250MedicaidUT

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in UT
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20040115001006 UT Practitioner - Emergency Medicine 3476454158 Reassigns benefits to 1 organization

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
374573-1205UTMDEmergency Medical Services (Emergency Medicine) Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Emergency Physicians Integrated Care, LLC Emergency Medicine CurrentSince Apr 28, 2014 Accepting new patients
Associates for Inpatient Medicine, LLC Past Accepting new patients

Locations

1600 W Antelope Dr
Layton, UT 84041
Phone (801) 807-1000

630 Medical Dr
North Salt Lake, UT 84010
Phone (801) 292-6231

2690 N 600 W
Pleasant View, UT 84414
Phone (801) 786-7911

3451 W 5600 S
Roy, UT 84067
Phone (801) 896-5600

1200 E 3900 S
Slc, UT 84124
Phone (801) 268-7111

1050 E South Temple
Slc, UT 84102
Phone (801) 350-4111

2500 S State St
South Salt Lake, UT 84115
Phone (385) 646-5000

2055 N Main St
Tooele, UT 84074
Phone (435) 843-3600

3580 W 90th S
West Jordan, UT 84088
Phone (801) 263-0810

3460 S Pioneer Pkwy
West Valley City, UT 84120
Phone (801) 964-3111

Organizations & group practices 2

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1145923200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1272931200000",
    "number": "1255397691",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "144 S 500 E",
            "address_2": "2ND FLOOR",
            "city": "SALT LAKE CITY",
            "state": "UT",
            "postal_code": "841021907"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1200 E 3900 S",
            "city": "SALT LAKE CITY",
            "state": "UT",
            "postal_code": "841241300",
            "telephone_number": "801-268-7975"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "LAWLISS",
        "first_name": "KATHLEEN",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-04-25",
        "last_updated": "2010-05-04",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207PE0004X",
            "taxonomy_group": "",
            "desc": "Emergency Medicine, Emergency Medical Services",
            "state": "UT",
            "license": "374573-1205",
            "primary": false
        },
        {
            "code": "207P00000X",
            "taxonomy_group": "",
            "desc": "Emergency Medicine",
            "state": "UT",
            "license": "374573-1205",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "D3250",
            "state": "UT"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Salt Lake City, UT

Sources for this page

Verify at the official NPI Registry.