NPIMap

Organization Active NPI

Wasatch Vascular Center LLC

  • Vascular & Interventional Radiology Physician
  • Salt Lake City, UT
National Provider Identifier
1558905398
Registry record updated Feb 10, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Vascular & Interventional Radiology PhysicianTaxonomy code 2085R0204X
Legal business name
WASATCH VASCULAR CENTER LLC
Practice address
3702 S State St Ste 103
Salt Lake City, UT 84115-5096
Phone
(801) 281-0027
Fax
(801) 262-1533
NPI assigned
Nov 5, 2019
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Feb 10, 2023

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

Authorized official

Name
Gregg Miller, MD
Title
Authorized Official
Phone
(610) 644-8900

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Vascular & Interventional Radiology PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 2085R0204X Primary

Addresses

Primary practice location

3702 S State St Ste 103
Salt Lake City, UT 84115-5096

Mailing address

40 Valley Stream Pkwy Ste 100
Malvern, PA 19355-1407
Phone (610) 644-8900

Other practice location 1

3702 S State St Ste 105
Salt Lake City, UT 84115-5096
Phone (801) 298-1300

Other practice location 2

3702 S State St Ste 111
Salt Lake City, UT 84115-5078
Phone (801) 281-0027

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in UT

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20200807002691 UT Part B Supplier - Clinic/Group Practice 1951726967 Receives reassigned benefits from 6 practitioners
Practice locations: South Salt Lake, UT

National Provider Directory

National Provider Directory

Member of 1

Organizations this organization is a member of, according to the National Provider Directory.

Member organizations 1

Organizations listed as members of this organization in the National Provider Directory.

Locations

3702 S State St
Ste 105
South Salt Lake, UT 84115

3702 S State St
Ste 111B
South Salt Lake, UT 84115
Phone (801) 281-0027

Practitioners & affiliated clinicians

Practitioners 22

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

View all 22

NPI Registry JSON

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

{
    "created_epoch": "1572912000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1675987200000",
    "number": "1558905398",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "40 VALLEY STREAM PKWY STE 100",
            "city": "MALVERN",
            "state": "PA",
            "postal_code": "193551407",
            "telephone_number": "610-644-8900"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3702 S STATE ST STE 103",
            "city": "SALT LAKE CITY",
            "state": "UT",
            "postal_code": "841155096",
            "telephone_number": "801-281-0027",
            "fax_number": "801-262-1533"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "3702 S State St Ste 105",
            "address_purpose": "LOCATION",
            "city": "Salt Lake City",
            "state": "UT",
            "postal_code": "841155096",
            "country_code": "US",
            "telephone_number": "801-298-1300",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "3702 S State St Ste 111",
            "address_purpose": "LOCATION",
            "city": "Salt Lake City",
            "state": "UT",
            "postal_code": "841155078",
            "country_code": "US",
            "telephone_number": "801-281-0027",
            "fax_number": "801-262-1533",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "WASATCH VASCULAR CENTER LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2019-11-05",
        "last_updated": "2023-02-10",
        "certification_date": "2023-02-10",
        "status": "A",
        "authorized_official_last_name": "MILLER",
        "authorized_official_first_name": "GREGG",
        "authorized_official_title_or_position": "AUTHORIZED OFFICIAL",
        "authorized_official_telephone_number": "610-644-8900",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "2085R0204X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Radiology, Vascular & Interventional Radiology",
            "state": null,
            "license": null,
            "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 Feb 10, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.