Individual provider Active NPI

Kevin Loras Havlik, MD

  • Pediatrics Physician
  • Salt Lake City, UT
National Provider Identifier
1558315796
Registry record updated Jun 26, 2009
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatrics PhysicianTaxonomy code 208000000X
License
1670191205 Issued in UT
Practice address
2000 S 900 E
Salt Lake City, UT 84105-3208
Phone
(801) 464-7600
Fax
(801) 464-7656
NPI assigned
May 20, 2006
Last updated
Jun 26, 2009By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jun 26, 2009

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatrics Physician 208000000X 1670191205 UT Primary

Addresses

Primary practice location

2000 S 900 E
Salt Lake City, UT 84105-3208

Mailing address

PO Box 27128
Salt Lake City, UT 84127-0128
Phone (801) 464-7600

Other identifiers 1

IdentifierTypeStateIssuer
942854057090MedicaidUT

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
I20080815000386 UT Practitioner - Pediatric Medicine 2466527031 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Pediatric Medicine
Education
University of Iowa, RJ & L Carver College of Medicine, 1980
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Ihc Health Services IncGroup PAC ID 1850209420, 3,948 clinicians

Practice addresses (Care Compare)

700 S Hwy 99
Fillmore, UT 84631-5134
Phone (435) 743-5555

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
1670191205UTMDPediatrics Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Ihc Health Services, Inc. CurrentSince Jan 1, 2008 Accepting new patients
Ihc Health Services Inc CurrentSince Jan 1, 2008 Accepting new patients
Ihc Health Services Inc Current Accepting new patients

Locations

98 N 1100 E
Ste 201
American Fork, UT 84003
Phone (801) 492-2475

700 S Highway 99
Fillmore, UT 84631
Phone (435) 743-5555

700 S Highway 99
Ste 3
Fillmore, UT 84631
Phone (435) 743-5555

454 E Medical Way
Heber City, UT 84032
Phone (435) 654-2500

201 W Layton Pkwy
Ste 1C
Layton, UT 84041
Phone (801) 387-4500

6272 S Highland Dr
Murray, UT 84121
Phone (801) 871-6000

505 W 400 N
Orem, UT 84057
Phone (801) 357-7525

3723 W 12600 S
Ste 330
Riverton, UT 84065
Phone (801) 285-4543

5063 S Cottonwood St
Ste 160
Salt Lake City, UT 84107
Phone (801) 507-1850

9450 S 1300 E
Sandy, UT 84094
Phone (801) 501-2133

2000 S 900 E
Slc, UT 84105
Phone (801) 446-7786

389 S 900 E
Slc, UT 84102
Phone (385) 282-2000

Organizations & group practices 3

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

NPI Registry JSON

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

{
    "created_epoch": "1148083200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1245974400000",
    "number": "1558315796",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 27128",
            "city": "SALT LAKE CITY",
            "state": "UT",
            "postal_code": "841270128",
            "telephone_number": "801-464-7600",
            "fax_number": "801-464-7656"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2000 S 900 E",
            "city": "SALT LAKE CITY",
            "state": "UT",
            "postal_code": "841053208",
            "telephone_number": "801-464-7600",
            "fax_number": "801-464-7656"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "HAVLIK",
        "first_name": "KEVIN",
        "middle_name": "LORAS",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-05-20",
        "last_updated": "2009-06-26",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "UT",
            "license": "1670191205",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "942854057090",
            "state": "UT"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Salt Lake City, UT

Sources for this page

Verify at the official NPI Registry.