Organization
PEDIATRIC CARDIOLOGY DEPARTMENT OF UNIVERSITY OF UTAH
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. EDWARD B CLARK MD (DEPT CHAIR)
(801) 587-7400
Entity
Organization
Contact information
Practice address
100 MARIO CAPECCHI DR, SALT LAKE CITY, UT 84113-1103
(801) 662-5400
(801) 662-5404
Mailing address
295 CHIPETA WAY, U OF U SOM DEPT OF PEDIATRICS, SALT LAKE CITY, UT 84108-1220
(801) 587-7400
(801) 587-7417
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
—
—
2080P0202X
Pediatric Cardiology Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100507101
—
NV
05
—
121313000
—
WY
05
—
200065910A
—
OK
05
—
200817950A
—
IN
05
—
22001832
—
CO
05
—
807148600
—
ID
Enumeration date
11/06/2006
Last updated
09/15/2009
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