Provider Demographics
NPI:1083962047
Name:UNIVERSITY OF UTAH HEALTH CARE
Entity Type:Organization
Organization Name:UNIVERSITY OF UTAH HEALTH CARE
Other - Org Name:SOUTH JORDAN HEALTH CENTER
Other - Org Type:Other Name
Authorized Official - Title/Position:PROVIDER ENROLLMENT
Authorized Official - Prefix:
Authorized Official - First Name:KINDRA
Authorized Official - Middle Name:
Authorized Official - Last Name:STOCKTON
Authorized Official - Suffix:IV
Authorized Official - Credentials:
Authorized Official - Phone:801-587-6336
Mailing Address - Street 1:5126 W DAYBREAK PKWY
Mailing Address - Street 2:
Mailing Address - City:SOUTH JORDAN
Mailing Address - State:UT
Mailing Address - Zip Code:84095-5994
Mailing Address - Country:US
Mailing Address - Phone:801-213-4500
Mailing Address - Fax:801-231-4837
Practice Address - Street 1:5126 W DAYBREAK PKWY
Practice Address - Street 2:
Practice Address - City:SOUTH JORDAN
Practice Address - State:UT
Practice Address - Zip Code:84095-5994
Practice Address - Country:US
Practice Address - Phone:801-213-4500
Practice Address - Fax:801-231-4837
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-08-23
Last Update Date:2012-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT8051588-1109282N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282N00000XHospitalsGeneral Acute Care Hospital