Healthcare Provider Details

I. General information

NPI: 1073647368
Provider Name (Legal Business Name): UNIVERSITY OF UTAH DEPT OF OBGYN MATERNAL FETAL MEDICINE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/16/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

50 N MEDICAL DR
SLC UT
84132-0001
US

IV. Provider business mailing address

PO BOX 58859
SLC UT
84158-0859
US

V. Phone/Fax

Practice location:
  • Phone: 801-581-2719
  • Fax:
Mailing address:
  • Phone: 801-213-3800
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207VM0101X
TaxonomyMaternal & Fetal Medicine Physician
License Number
License Number State

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name: ERIKA LINDLEY
Title or Position: CLINICAL ADMIN MANAGER
Credential:
Phone: 801-581-3115