Organization
PEDIATRIC ORTHOPEDIC ASSOCIATES
Active
Organization subpart
No
Provider details
NPI number
Authorized official
ALAN KENDRICK STOTTS MD (DEPARTMENT CHAIR)
(801) 588-3900
Entity
Organization
Contact information
Practice address
100 MARIO CAPECCHI DR, SALT LAKE CITY, UT 84112-8924
(801) 588-3900
Mailing address
PO BOX 58886, SALT LAKE CITY, UT 84158-0886
(801) 213-8300
Taxonomy
Speciality
Code
Description
License number
State
2085B0100X
Body Imaging Physician
—
—
2085N0700X
Neuroradiology Physician
—
—
2085P0229X
Pediatric Radiology Physician
Primary
—
—
2085R0202X
Diagnostic Radiology Physician
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
122394100
WYOMING MEDICIAD
WY
01
—
22074538
COLORADO MEDICAID
CO
01
—
806656500
IDAHO MEDICAID
ID
Enumeration date
08/24/2006
Last updated
10/16/2008
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