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General NPI Number Information
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NPI Number | 1134393499
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Entity Type | Organization
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Legal Business Name | CITY CREEK MEDICAL SPECIALISTS, INC
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Dates
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Enumeration Date | 04/17/2008
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Last Update Date | 07/21/2022
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Provider Practice Location Address
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Address Line | UNIV OF UTAH MEDICAL HOSPITAL 50 NORTH DR
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City | SALT LAKE CITY
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State | UT
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Zip | 84132-2853
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Country | US
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Telephone | 801-581-2121
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Fax | 801-408-3598
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Provider Business Mailing Address
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Address Line | 324 TENTH AVE SUITE 160
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City | SALT LAKE CITY
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State | UT
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Zip | 84103-2853
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Country | US
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Telephone | 801-408-5151
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Fax | 801-408-3598
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. ANN JEFFERDS
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Credential | M.D.
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Telephone | 801-408-5151
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | 56382771205
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License Number State | UT
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Taxonomy #2
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | 1737701205
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License Number State | UT
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Taxonomy #3
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | 5740231205
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License Number State | UT
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Taxonomy #4
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | 1816141205
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License Number State | UT
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