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
Update your record
If you believe information in your NPPES record is inaccurate, or if you wish to update or deactivate your NPI, you can do so directly with CMS at https://nppes.cms.hhs.gov.
About Stedi
Stedi is the only programmable healthcare clearinghouse. You can use Stedi's APIs to process eligibility checks, claims, remits, and more.
Sign up