Plastic Surgery Institute of Utah

Primary specialty

Clinic/CenterTaxonomy code 261Q00000X

Legal business name

PLASTIC SURGERY INSTITUTE OF UTAH

Doing business as

Doctor/Owner

Practice address

7535 S Union Park Ave
Midvale, UT 84047-3043

Phone

(801) 859-9004

Fax

(877) 595-1086

NPI assigned

Apr 6, 2022

Organization subpart

No

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

Authorized official

Name

Michael Kirk Moore, MD

Title

Owner

Phone

(801) 685-2730

Specialties & licenses 1

Addresses

Other names 1

• Doctor/Owner Doing business as

Locations

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

{
    "created_epoch": "1649203200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1649203200000",
    "number": "1659012292",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "7535 S UNION PARK AVE",
            "city": "MIDVALE",
            "state": "UT",
            "postal_code": "840473043",
            "telephone_number": "801-859-9004",
            "fax_number": "877-595-1086"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "7535 S UNION PARK AVE",
            "city": "MIDVALE",
            "state": "UT",
            "postal_code": "840473043",
            "telephone_number": "801-859-9004",
            "fax_number": "877-595-1086"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PLASTIC SURGERY INSTITUTE OF UTAH",
        "organizational_subpart": "NO",
        "enumeration_date": "2022-04-06",
        "last_updated": "2022-04-06",
        "certification_date": "2022-04-06",
        "status": "A",
        "authorized_official_last_name": "MOORE",
        "authorized_official_first_name": "MICHAEL",
        "authorized_official_middle_name": "KIRK",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "801-685-2730",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "261Q00000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Doctor/Owner",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• PHC of Utah, Inc. (Highland Ridge Hospital)
• PHC of Utah, Inc. (Highland Ridge Hospital)
• Physical Therapy Recovery LLC (Physical Therapy Recovery)
• Jessica Ann Pierce
• Matthew Pierce, PA-C
• Daniel Johnson Poelman, DDS
• Jaron Pope, PT
• Mia Popernack
• Elizabeth Porter
• Jeremy Pottash

• Clinic/Center in Midvale, UT
• Providers in Midvale, UT by specialty
• Clinic/Center in Utah

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 6, 2022; 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.