Provider Demographics
NPI:1407155591
Name:UNIVERSITY OF UTAH PEDIATRIC ADOLESCENT PROFESSIONAL SERVICES
Entity Type:Organization
Organization Name:UNIVERSITY OF UTAH PEDIATRIC ADOLESCENT PROFESSIONAL SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DEPARTMENT CHAIR
Authorized Official - Prefix:
Authorized Official - First Name:HOWARD
Authorized Official - Middle Name:R
Authorized Official - Last Name:WEEKS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:801-585-1575
Mailing Address - Street 1:PO BOX 413076
Mailing Address - Street 2:
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84141-3076
Mailing Address - Country:US
Mailing Address - Phone:801-587-6688
Mailing Address - Fax:
Practice Address - Street 1:501 CHIPETA WAY
Practice Address - Street 2:
Practice Address - City:SALT LAKE CITY
Practice Address - State:UT
Practice Address - Zip Code:84108-1222
Practice Address - Country:US
Practice Address - Phone:801-585-1575
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-03-15
Last Update Date:2011-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0804XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyChild & Adolescent PsychiatryGroup - Multi-Specialty