NPIMap

Organization Active NPI

Park City Internal Medicine - Pediatrics, LC

  • Health Service Clinic/Center
  • Park City, UT
National Provider Identifier
1750569562
Registry record updated May 18, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
Health Service Clinic/CenterTaxonomy code 261QH0100X
License
5151398-1205 Issued in UT
Legal business name
PARK CITY INTERNAL MEDICINE - PEDIATRICS, LC
Practice address
1612 Ute Blvd
Ste 205
Park City, UT 84098-7500
Phone
(435) 655-3309
Fax
(435) 655-3392
NPI assigned
Feb 4, 2008
Organization subpart
No

NPPES NPI Registry

Updated by the provider on May 18, 2011

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

Authorized official

Name
Penny Peacock, MDNPI 1902864762
Title
Owner
Phone
(435) 655-3309

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Health Service Clinic/Center 261QH0100X 5151398-1205 UT Primary

Addresses

Primary practice location

1612 Ute Blvd
Ste 205
Park City, UT 84098-7500

Mailing address

1612 Ute Blvd
Ste 205
Park City, UT 84098-7500
Phone (435) 655-3309

National Provider Directory

National Provider Directory

Locations

1612 Ute Blvd
Ste 112
Park City, UT 84098
Phone (435) 655-3309

1612 Ute Blvd
Ste 205
Park City, UT 84098
Phone (435) 655-3309

Practitioners & affiliated clinicians

Practitioners 4

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

NPI Registry JSON

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

{
    "created_epoch": "1202083200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1305676800000",
    "number": "1750569562",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1612 UTE BLVD",
            "address_2": "STE 205",
            "city": "PARK CITY",
            "state": "UT",
            "postal_code": "840987500",
            "telephone_number": "435-655-3309",
            "fax_number": "435-655-3392"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1612 UTE BLVD",
            "address_2": "STE 205",
            "city": "PARK CITY",
            "state": "UT",
            "postal_code": "840987500",
            "telephone_number": "435-655-3309",
            "fax_number": "435-655-3392"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PARK CITY INTERNAL MEDICINE - PEDIATRICS, LC",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-02-04",
        "last_updated": "2011-05-18",
        "status": "A",
        "authorized_official_last_name": "PEACOCK",
        "authorized_official_first_name": "PENNY",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "435-655-3309",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "261QH0100X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Health Service",
            "state": "UT",
            "license": "5151398-1205",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Park City, UT

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 18, 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.