Basic Information
| Provider Information | |||||||||
| NPI: | 1568494060 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | VA HEALTH CARE SYSTEM, SALT LAKE CITY, UT | ||||||||
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| Mailing Information | |||||||||
| Address1: | 4324 GARDEN DR | ||||||||
| Address2: | |||||||||
| City: | SALT LAKE CITY | ||||||||
| State: | UT | ||||||||
| PostalCode: | 841242406 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8012633563 | ||||||||
| FaxNumber: | 8012633563 | ||||||||
| Practice Location | |||||||||
| Address1: | 500 FOOTHILL BLVD | ||||||||
| Address2: | |||||||||
| City: | SALT LAKE CITY | ||||||||
| State: | UT | ||||||||
| PostalCode: | 841480001 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8015821565 | ||||||||
| FaxNumber: | 8015841297 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/06/2006 | ||||||||
| LastUpdateDate: | 08/22/2020 | ||||||||
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| AuthorizedOfficialLastName: | SARKER | ||||||||
| AuthorizedOfficialFirstName: | ASHIT | ||||||||
| AuthorizedOfficialMiddleName: | BARAN | ||||||||
| AuthorizedOfficialTitleorPosition: | PATHOLOGIST | ||||||||
| AuthorizedOfficialTelephone: | 8015821565 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 284300000X | 5678120-1205 | UT | X | Hospitals | Special Hospital | 291U00000X | 5678120-1205 | UT | X | Laboratories | Clinical Medical Laboratory |
No ID Information.