Organization
UNIVERSITY OF UTAH PEDIATRIC SERVICES
Active
Parent organization
UNIVERSITY OF UTAH PEDIATRIC SERVICES
Organization subpart
Yes
Provider details
NPI number
Legal business name
UNIVERSITY OF UTAH PEDIATRIC SERVICES
Authorized official
EDWARD CLARK MD (DEPARTMENT CHAIR)
(801) 587-6336
Entity
Organization
Contact information
Practice address
100 N MARIO CAPECCHI DR, SALT LAKE CITY, UT 84113-1103
(801) 587-6336
Mailing address
PO BOX 413021, SALT LAKE CITY, UT 84141-3021
(801) 213-3900
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Primary
—
—
Other
Enumeration date
05/25/2016
Last updated
05/25/2016
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