Basic Information
| Provider Information | |||||||||
| NPI: | 1770512238 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | CHRISTENSEN | ||||||||
| FirstName: | SCOTT | ||||||||
| MiddleName: | K | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 58202 | ||||||||
| Address2: | |||||||||
| City: | SALT LAKE CITY | ||||||||
| State: | UT | ||||||||
| PostalCode: | 841580202 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8015833395 | ||||||||
| FaxNumber: | 8015832175 | ||||||||
| Practice Location | |||||||||
| Address1: | 3580 W 9000 S | ||||||||
| Address2: | |||||||||
| City: | WEST JORDAN | ||||||||
| State: | UT | ||||||||
| PostalCode: | 840888812 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8015618888 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 06/30/2006 | ||||||||
| LastUpdateDate: | 08/27/2010 | ||||||||
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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 | 207L00000X | 781622081205 | UT | Y | Allopathic & Osteopathic Physicians | Anesthesiology | 207LP3000X | 781622081205 | UT | N | Allopathic & Osteopathic Physicians | Anesthesiology | Pediatric Anesthesiology |
ID Information
| ID | Type | State | Issuer | Description | 353638700 | 01 | UT | US DEPT LABOR | OTHER | QM0000054602 | 01 | UT | ALTIUS | OTHER | 870484603CHR | 01 | UT | EDUCATOR MUTUAL | OTHER | 050087245 | 01 | UT | MEDICARE A | OTHER | 87042 | 01 | UT | UPRR | OTHER | 5177981 | 01 | UT | CCN | OTHER |