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Organization
PEDIATRIC EMERGENCY SEDATION SERVICE
Active
Organization
PEDIATRIC EMERGENCY SEDATION SERVICE
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. JANELL MADONNA (CONTRACTING DIRECTOR)
(801) 587-6464
Entity
Organization
Contact information
Practice address
100 MARIO CAPECCHI DR, SALT LAKE CITY, UT 84113-1103
(801) 662-1234
Mailing address
PO BOX 413021, SALT LAKE CITY, UT 84141-3021
(801) 213-3900
Taxonomy
Speciality
Code
Description
License number
State
2080P0204X
Pediatric Emergency Medicine (Pediatrics) Physician
Primary
3176341205
UT
Other
Enumeration date
06/02/2011
Last updated
09/06/2011
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