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NPI Code Detail

MEDICARE: MATTHEW S ADAMS CRNA

MEDICARE: MATTHEW S ADAMS CRNA
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1367500000XCertified Registered Nurse Anesthetist277906-4406UT

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1107013910101OTHERUTIHC
270918OTHERUTPEHP
3774664OTHERUTDESERET MUTUAL
4QM0000054865OTHERUTALTIUS
527760944000001OTHERUTBCBS
679200OTHERUTHEALTHY U
7TPRA06823OTHERUTMOLINA

General Provider Information

NPI Number : 1013013838
Entity Type Code : Individual
Provider Name (Legal Business Name) : MATTHEW S ADAMS CRNA
Provider Business Mailing Address
First Line : 1954 FORT UNION BLVD STE 114
Second Line :
City : SALT LAKE CITY
State : UT
Zip : 84121-6899
Country : US
Telephone Number : 800-594-5736
Fax Number :
Provider Business Practice Location Address
First Line : 1954 FORT UNION BLVD STE 114
Second Line :
City : SALT LAKE CITY
State : UT
Zip : 84121-6899
Country : US
Telephone Number : 800-594-5736
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/16/2006
Last Update Date : 09/24/2007

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