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General NPI Number Information
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NPI Number | 1508875857
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Entity Type | Organization
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Legal Business Name | UNIVERSITY OF UTAH OTOLARYNGOLOGY PEDIATRICS
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Dates
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Enumeration Date | 08/05/2006
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Last Update Date | 04/14/2009
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Provider Practice Location Address
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Address Line | 100 MARIO CAPECCHI DR
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City | SALT LAKE CITY
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State | UT
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Zip | 84113-1103
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Country | US
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Telephone | 801-588-2000
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 413035
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City | SALT LAKE CITY
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State | UT
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Zip | 84141-0001
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Country | US
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Telephone | 801-213-3800
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Fax |
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Authorized Official
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Title or Position | DIRECTOR OF CONTRACTING AND PE
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Name | JANELL I MADONNA
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Credential |
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Telephone | 801-587-6464
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207YP0228X
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Taxonomy Name | Pediatric Otolaryngology Physician
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 231H00000X
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Taxonomy Name | Audiologist
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 231HA2400X
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Taxonomy Name | Assistive Technology Practitioner Audiologist
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 207Y00000X
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Taxonomy Name | Otolaryngology Physician
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License Number |
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License Number State |
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