University Of Utah Pediatric Services
Pediatrics, Pediatric Cardiology in Pocatello, ID. Organization (NPI-2).
NPI number1154783017
StatusActive
Last updated in NPPESJan 22, 2021
Details
- NPI
- 1154783017
- Entity type
- Organization (NPI-2)
- Legal business name
- University Of Utah Pediatric Services
- Organization subpart
- Yes
- Enumeration date
- Mar 22, 2016
- Certification date
- Jan 22, 2021
- Last updated
- Jan 22, 2021
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 2080P0202X | Pediatrics, Pediatric Cardiology | – | – | Yes |
Other names
- Portneuf Medical Center - Pediatric Cardiology (Doing Business As)
Practice location
777 Hospital WayPocatello, ID 83201-5175
Phone 801-587-6336
Mailing address
Po Box 841450Los Angeles, CA 90084-1450
Phone 801-213-3900
Authorized official
Samuel Finlayson
Chief Clinical Officer
8015876336
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