Organization
UNIVERSITY CARDIOTHORACIC-PEDIATRIC
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 58049, SALT LAKE CITY, UT 84158-0049
(801) 588-3345
Taxonomy
Speciality
Code
Description
License number
State
208600000X
Surgery Physician
Primary
—
—
2086S0120X
Pediatric Surgery Physician
—
—
208G00000X
Thoracic Surgery (Cardiothoracic Vascular Surgery) Physician
—
—
Other
Enumeration date
08/05/2006
Last updated
04/14/2009
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