Basic Information
| Provider Information | |||||||||
| NPI: | 1013013838 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | ADAMS | ||||||||
| FirstName: | MATTHEW | ||||||||
| MiddleName: | S | ||||||||
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| Credential: | CRNA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1954 FORT UNION BLVD STE 114 | ||||||||
| Address2: | |||||||||
| City: | SALT LAKE CITY | ||||||||
| State: | UT | ||||||||
| PostalCode: | 841216899 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8005945736 | ||||||||
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| Practice Location | |||||||||
| Address1: | 1954 FORT UNION BLVD STE 114 | ||||||||
| Address2: | |||||||||
| City: | SALT LAKE CITY | ||||||||
| State: | UT | ||||||||
| PostalCode: | 841216899 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8005945736 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/16/2006 | ||||||||
| LastUpdateDate: | 09/24/2007 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 367500000X | 277906-4406 | UT | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Anesthetist, Certified Registered |
ID Information
| ID | Type | State | Issuer | Description | 107013910101 | 01 | UT | IHC | OTHER | 70918 | 01 | UT | PEHP | OTHER | 774664 | 01 | UT | DESERET MUTUAL | OTHER | QM0000054865 | 01 | UT | ALTIUS | OTHER | 27760944000001 | 01 | UT | BCBS | OTHER | 79200 | 01 | UT | HEALTHY U | OTHER | TPRA06823 | 01 | UT | MOLINA | OTHER |