Provider Demographics
NPI:1013013838
Name:ADAMS, MATTHEW S (CRNA)
Entity Type:Individual
Prefix:
First Name:MATTHEW
Middle Name:S
Last Name:ADAMS
Suffix:
Gender:M
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1954 FORT UNION BLVD STE 114
Mailing Address - Street 2:
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84121-6899
Mailing Address - Country:US
Mailing Address - Phone:800-594-5736
Mailing Address - Fax:
Practice Address - Street 1:1954 FORT UNION BLVD STE 114
Practice Address - Street 2:
Practice Address - City:SALT LAKE CITY
Practice Address - State:UT
Practice Address - Zip Code:84121-6899
Practice Address - Country:US
Practice Address - Phone:800-594-5736
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-09-16
Last Update Date:2007-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT277906-4406367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT107013910101OtherIHC
UT70918OtherPEHP
UT774664OtherDESERET MUTUAL
UTQM0000054865OtherALTIUS
UT27760944000001OtherBCBS
UT79200OtherHEALTHY U
UTTPRA06823OtherMOLINA
UT774664OtherDESERET MUTUAL