1487734976 NPI number — UNIVERSITY OF UTAH

Table of content: (NPI 1487734976)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1487734976 NPI number — UNIVERSITY OF UTAH

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
UNIVERSITY OF UTAH
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
HUNTSMAN MENTAL HEALTH INSTITUTE
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1487734976
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/16/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 511258
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LOS ANGELES
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
90051-7813
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
801-583-2500
Provider Business Mailing Address Fax Number:
801-585-6363

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
501 S CHIPETA WAY
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SALT LAKE CITY
Provider Business Practice Location Address State Name:
UT
Provider Business Practice Location Address Postal Code:
84108-1222
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
801-581-2353
Provider Business Practice Location Address Fax Number:
801-585-6363
Provider Enumeration Date:
10/17/2006

Additional Information

Authorized Official

Authorized Official Last Name:
PARK
Authorized Official First Name:
CHARLTON
Authorized Official Middle Name:
Authorized Official Title or Position:
CHIEF FINANCIAL OFFICER
Authorized Official Telephone Number:
801-585-1325

Provider Taxonomy Codes

  • Taxonomy code: 283Q00000X , with the licence number:  2006-HOSP-657 , registered in the state of UT ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 46S0009 , issued by the state of ( UT ) . This identifiers is of the category "MEDICAID".




Copyright © 2007-2024 www.npivalidator.com