Organization
STATE OF UTAH
Active
Other names
Children with Special Health Care Needs (CSHCN(
Organization subpart
No
Provider details
NPI number
Authorized official
KIM L ROMERO (BUREAU DIRECTOR, FINANCIAL RESCOURC)
(801) 538-6911
Entity
Organization
Contact information
Practice address
44 N MARIO CAPPECI DRIVE, SALT LAKE CITY, UT 84114
(801) 584-8239
Mailing address
PO BOX 142001, SALT LAKE CITY, UT 84114-2001
(801) 538-6709
(801) 538-6591
Taxonomy
Speciality
Code
Description
License number
State
251K00000X
Public Health or Welfare Agency
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
999000021033
—
UT
Enumeration date
09/05/2006
Last updated
08/20/2009
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