Healthcare Provider Details

I. General information

NPI: 1083962047
Provider Name (Legal Business Name): UNIVERSITY OF UTAH HEALTH CARE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/23/2012
Last Update Date: 08/23/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5126 W DAYBREAK PKWY
SOUTH JORDAN UT
84095-5994
US

IV. Provider business mailing address

5126 W DAYBREAK PKWY
SOUTH JORDAN UT
84095-5994
US

V. Phone/Fax

Practice location:
  • Phone: 801-213-4500
  • Fax: 801-231-4837
Mailing address:
  • Phone: 801-213-4500
  • Fax: 801-231-4837

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code282N00000X
TaxonomyGeneral Acute Care Hospital
License Number8051588-1109
License Number StateUT

VIII. Authorized Official

Name: KINDRA STOCKTON IV
Title or Position: PROVIDER ENROLLMENT
Credential:
Phone: 801-587-6336