Provider Demographics
NPI:1376597344
Name:UTAH HEALTHCARE INSTITUTE INC
Entity Type:Organization
Organization Name:UTAH HEALTHCARE INSTITUTE INC
Other - Org Name:ST. MARK'S FAMILY MEDICINE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR/OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:
Authorized Official - Last Name:BERNEIKE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:801-265-2000
Mailing Address - Street 1:1250 E 3900 S
Mailing Address - Street 2:SUITE 260
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84124-1348
Mailing Address - Country:US
Mailing Address - Phone:801-265-2000
Mailing Address - Fax:801-265-2008
Practice Address - Street 1:1250 E 3900 S
Practice Address - Street 2:SUITE 260
Practice Address - City:SALT LAKE CITY
Practice Address - State:UT
Practice Address - Zip Code:84124-1348
Practice Address - Country:US
Practice Address - Phone:801-265-2000
Practice Address - Fax:801-265-2008
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-22
Last Update Date:2016-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT1376597344Medicaid
UT000057162Medicare PIN
UT=========OtherCLINIC/GROUP EIN NUMBER