# PEDIATRIC NEPHROLOGY DEPARTMENT OF UNIVERSITY OF UTAH

> Is this information incorrect? This page shows public data from NPPES. Update your record in NPPES and this page will update automatically within 7 days. [Update your NPPES record](https://nppes.cms.hhs.gov)

- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1114027968
- **Authorized official:** DR. EDWARD B CLARK MD (DEPT CHAIR)
- **Authorized official phone:** (801) 587-7400

## Contact information

- **Practice address:** 100 N MEDICAL DR, PEDIATRIC NEPHROLOGY, SALT LAKE CITY, UT 84113-1103
- **Practice address phone:** (801) 588-2000
- **Practice address fax:** (801) 587-7406
- **Mailing address:** 295 CHIPETA WAY, U OF U SOM DEPT OF PEDIATRICS, SALT LAKE CITY, UT 84108-1220
- **Mailing address phone:** (801) 587-7400
- **Mailing address fax:** (801) 587-7417

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 208000000X | Pediatrics Physician | — | NULL | — |
| 208000000X | Pediatrics Physician | — | — | — |
| 2080P0210X | Pediatric Nephrology Physician | — | NULL | Yes |
| 2080P0210X | Pediatric Nephrology Physician | — | — | Yes |

## Other

- **Enumeration date:** 09/22/2006
- **Last updated:** 09/06/2011