Basic Information
| Provider Information | |||||||||
| NPI: | 1598967937 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | UNIVERSITY HEALTH CARE | ||||||||
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| Mailing Information | |||||||||
| Address1: | 90 L ST | ||||||||
| Address2: | |||||||||
| City: | SALT LAKE CITY | ||||||||
| State: | UT | ||||||||
| PostalCode: | 841033470 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8015501271 | ||||||||
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| Practice Location | |||||||||
| Address1: | 30 N 1900 E | ||||||||
| Address2: | 3R210 | ||||||||
| City: | SALT LAKE CITY | ||||||||
| State: | UT | ||||||||
| PostalCode: | 841322305 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8015856387 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 06/05/2007 | ||||||||
| LastUpdateDate: | 08/22/2020 | ||||||||
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| AuthorizedOfficialLastName: | ORME | ||||||||
| AuthorizedOfficialFirstName: | HEIDI | ||||||||
| AuthorizedOfficialMiddleName: | T | ||||||||
| AuthorizedOfficialTitleorPosition: | NEUROLOGIST | ||||||||
| AuthorizedOfficialTelephone: | 8015856387 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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| AuthorizedOfficialCredential: | M.D. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261QM2500X | 6076548-1205 | UT | X | Ambulatory Health Care Facilities | Clinic/Center | Medical Specialty | 282N00000X | 6029568-1205 | UT | X | Hospitals | General Acute Care Hospital |
No ID Information.