Healthcare Provider Details

I. General information

NPI: 1881708766
Provider Name (Legal Business Name): UNIVERSITY OF UTAH
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/18/2006
Last Update Date: 12/09/2025
Certification Date: 12/09/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

85 N MEDICAL DR
SALT LAKE CITY UT
84112-1100
US

IV. Provider business mailing address

PO BOX 511258
LOS ANGELES CA
90051-7813
US

V. Phone/Fax

Practice location:
  • Phone: 801-581-2121
  • Fax:
Mailing address:
  • Phone: 801-587-6760
  • Fax: 801-587-6675

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code283X00000X
TaxonomyRehabilitation Hospital
License Number2006-HOSP-208
License Number StateUT
# 2
Primary TaxonomyY
Taxonomy Code283X00000X
TaxonomyRehabilitation Hospital
License Number2006-HOSP208
License Number StateUT

VIII. Authorized Official

Name: CHARLTON PARK
Title or Position: CFO
Credential:
Phone: 801-585-1325