NPIMap

Organization Active NPI

University of Utah Division of Pediatric Neurosurgery

  • Neurological Surgery Physician
  • Salt Lake City, UT
National Provider Identifier
1417068271
Registry record updated Sep 6, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
Neurological Surgery PhysicianTaxonomy code 207T00000X
Legal business name
UNIVERSITY OF UTAH DIVISION OF PEDIATRIC NEUROSURGERY
Practice address
100 N Medical Dr
Suite 2400
Salt Lake City, UT 84113-1103
Phone
(801) 588-3400
Fax
(801) 588-3409
NPI assigned
Aug 31, 2006
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
Dr. William T Couldwell, MD
Title
Dept Chair
Phone
(801) 581-6909

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Neurological Surgery PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207T00000X Primary
Pediatric Surgery PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 2086S0120X

Addresses

Primary practice location

100 N Medical Dr
Suite 2400
Salt Lake City, UT 84113-1103

Mailing address

50 N Medical Dr
3B409-Som
Salt Lake City, UT 84132-0001
Phone (801) 581-6909

Other identifiers 9

IdentifierTypeStateIssuer
100389310AMedicaidIN
003073800MedicaidID
7123755MedicaidWA
X9X042036MedicaidTX
100501144MedicaidNV
200019110AMedicaidOK
29584205MedicaidCO
837253MedicaidNM
116059100MedicaidWY

National Provider Directory

National Provider Directory

Locations

100 N Medical Dr
Ste 2400
Salt Lake City, UT 84112
Phone (801) 588-3400

NPI Registry JSON

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

{
    "created_epoch": "1156982400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1315267200000",
    "number": "1417068271",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "50 N MEDICAL DR",
            "address_2": "3B409-SOM",
            "city": "SALT LAKE CITY",
            "state": "UT",
            "postal_code": "841320001",
            "telephone_number": "801-581-6909",
            "fax_number": "801-581-4385"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "100 N MEDICAL DR",
            "address_2": "SUITE 2400",
            "city": "SALT LAKE CITY",
            "state": "UT",
            "postal_code": "841131103",
            "telephone_number": "801-588-3400",
            "fax_number": "801-588-3409"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "UNIVERSITY OF UTAH DIVISION OF PEDIATRIC NEUROSURGERY",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-08-31",
        "last_updated": "2011-09-06",
        "status": "A",
        "authorized_official_last_name": "COULDWELL",
        "authorized_official_first_name": "WILLIAM",
        "authorized_official_middle_name": "T",
        "authorized_official_title_or_position": "DEPT CHAIR",
        "authorized_official_telephone_number": "801-581-6909",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207T00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Neurological Surgery",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "2086S0120X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Surgery, Pediatric Surgery",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "100389310A",
            "state": "IN"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "003073800",
            "state": "ID"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "7123755",
            "state": "WA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "X9X042036",
            "state": "TX"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "100501144",
            "state": "NV"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "200019110A",
            "state": "OK"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "29584205",
            "state": "CO"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "837253",
            "state": "NM"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "116059100",
            "state": "WY"
        }
    ],
    "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.