Healthcare Provider Details

I. General information

NPI: 1497014781
Provider Name (Legal Business Name): U-U ANESTHESIOLOGY DEPARTMENT NCC-SICU SCHOOL OF MEDICINE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/08/2012
Last Update Date: 05/08/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

50 N MEDICAL DR
SALT LAKE CITY UT
84132-0100
US

IV. Provider business mailing address

PO BOX 413034
SALT LAKE CITY UT
84141-3034
US

V. Phone/Fax

Practice location:
  • Phone: 801-581-6393
  • Fax:
Mailing address:
  • Phone: 801-213-3900
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207LC0200X
TaxonomyCritical Care Medicine (Anesthesiology) Physician
License Number
License Number State

VIII. Authorized Official

Name: LEMOYNE ADAMS
Title or Position: CLINICIAL ADMIN MANAGER
Credential:
Phone: 801-585-0777