Organization
UNIVERSITY OF UTAH OTOLARYNGOLOGY PEDIATRICS
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JANELL I MADONNA (DIRECTOR OF CONTRACTING AND PE)
(801) 587-6464
Entity
Organization
Contact information
Practice address
100 MARIO CAPECCHI DR, SALT LAKE CITY, UT 84113-1103
(801) 588-2000
Mailing address
PO BOX 413035, SALT LAKE CITY, UT 84141-0001
(801) 213-3800
Taxonomy
Speciality
Code
Description
License number
State
207Y00000X
Otolaryngology Physician
Primary
—
—
207YP0228X
Pediatric Otolaryngology Physician
—
—
231H00000X
Audiologist
—
—
231HA2400X
Assistive Technology Practitioner Audiologist
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
45200289
—
CO
05
—
57507325
—
NM
05
—
805957800
—
ID
01
—
CJ3240
RAILROAD MEDICARE
UT
Enumeration date
08/05/2006
Last updated
04/14/2009
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