Organization
PEDIATRIC CRITICAL CARE DEPARTMENT OF UNIVERSITY OF UTAH
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. EDWARD B CLARK MD (CHAIR)
(801) 587-7400
Entity
Organization
Contact information
Practice address
100 MARIO CAPECCHI DR, SALT LAKE CITY, UT 84113-1103
(801) 662-1000
(801) 213-3320
Mailing address
295 CHIPETA WAY, PEDS ADMIN, SALT LAKE CITY, UT 84108-1220
(801) 587-7400
(801) 587-7417
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
—
—
2080P0203X
Pediatric Critical Care Medicine Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100507101
—
NV
05
—
121357100
—
WY
05
—
807147600
—
ID
Enumeration date
05/19/2006
Last updated
06/25/2009
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