Provider Demographics
NPI:1306016712
Name:RICHARD SCHWARTZ MD PC
Entity Type:Organization
Organization Name:RICHARD SCHWARTZ MD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:CAIT
Authorized Official - Middle Name:
Authorized Official - Last Name:KENNEDY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:801-261-8507
Mailing Address - Street 1:1220 E 3900 S
Mailing Address - Street 2:SUITE 4E
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84124-1327
Mailing Address - Country:US
Mailing Address - Phone:801-261-8507
Mailing Address - Fax:801-261-8511
Practice Address - Street 1:1220 E 3900 S
Practice Address - Street 2:SUITE 4E
Practice Address - City:SALT LAKE CITY
Practice Address - State:UT
Practice Address - Zip Code:84124-1327
Practice Address - Country:US
Practice Address - Phone:801-261-8507
Practice Address - Fax:801-261-8511
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-03
Last Update Date:2011-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT180567-1205207T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207T00000XAllopathic & Osteopathic PhysiciansNeurological SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
UTC91584OtherUPIN
UT000055943Medicare PIN