Provider Demographics
NPI:1417121609
Name:UTAH ENDOCRINOLOGY ASSOCIATES PLLC
Entity Type:Organization
Organization Name:UTAH ENDOCRINOLOGY ASSOCIATES PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BILLING/CREDENTIALING
Authorized Official - Prefix:
Authorized Official - First Name:SHARON
Authorized Official - Middle Name:
Authorized Official - Last Name:PRESTON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:801-747-2800
Mailing Address - Street 1:470 E 3900 S STE 200
Mailing Address - Street 2:
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84107-2332
Mailing Address - Country:US
Mailing Address - Phone:801-747-2800
Mailing Address - Fax:801-747-5222
Practice Address - Street 1:470 EAST 3900 SOUTH
Practice Address - Street 2:#200
Practice Address - City:SALT LAKE CITY
Practice Address - State:UT
Practice Address - Zip Code:84107-2332
Practice Address - Country:US
Practice Address - Phone:801-747-2800
Practice Address - Fax:801-747-3022
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-17
Last Update Date:2022-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT4848079-1205207RE0101X
207RE0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & MetabolismGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT000063492Medicare PIN