Pediatric Critical Care Department of University of Utah

Primary specialty

Pediatric Critical Care Medicine PhysicianTaxonomy code 2080P0203X

Legal business name

PEDIATRIC CRITICAL CARE DEPARTMENT OF UNIVERSITY OF UTAH

Practice address

100 Mario Capecchi Dr
Salt Lake City, UT 84113-1103

Phone

(801) 662-1000

Fax

(801) 213-3320

NPI assigned

May 19, 2006

Organization subpart

No

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

Authorized official

Name

Dr. Edward B Clark, MD

Title

Chair

Phone

(801) 587-7400

Specialties & licenses 2

Addresses

Other identifiers 3

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

{
    "created_epoch": "1147996800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1245888000000",
    "number": "1922052604",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "295 CHIPETA WAY",
            "address_2": "PEDS ADMIN",
            "city": "SALT LAKE CITY",
            "state": "UT",
            "postal_code": "841081220",
            "telephone_number": "801-587-7400",
            "fax_number": "801-587-7417"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "100 MARIO CAPECCHI DR",
            "city": "SALT LAKE CITY",
            "state": "UT",
            "postal_code": "841131103",
            "telephone_number": "801-662-1000",
            "fax_number": "801-213-3320"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PEDIATRIC CRITICAL CARE DEPARTMENT OF UNIVERSITY OF UTAH",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-05-19",
        "last_updated": "2009-06-25",
        "status": "A",
        "authorized_official_last_name": "CLARK",
        "authorized_official_first_name": "EDWARD",
        "authorized_official_middle_name": "B",
        "authorized_official_title_or_position": "CHAIR",
        "authorized_official_telephone_number": "801-587-7400",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Pediatrics",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "2080P0203X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Pediatrics, Pediatric Critical Care Medicine",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "100507101",
            "state": "NV"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "121357100",
            "state": "WY"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "807147600",
            "state": "ID"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Pediatric Allergy
• Pediatric Anesthesiologists Inc
• Pediatric Behavioral Health
• Pediatric Bone Marrow Transplant Department of University of Utah
• Pediatric Cardiology Department of University of Utah
• Pediatric Emergency Medicine Department of University of Utah
• Pediatric Emergency Sedation Service
• Pediatric Endocrinology Department of University of Utah
• Pediatric Gastroenterology Department of University of Utah
• Pediatric Genetics Department of University of Utah

• Pediatric Critical Care Medicine Physician in Salt Lake City, UT
• Providers in Salt Lake City, UT by specialty
• Pediatric Critical Care Medicine Physician in Utah

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 25, 2009; 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.