Provider Demographics
NPI:1518907831
Name:UNIVERSITY RADIATION ONCOLOGISTS
Entity Type:Organization
Organization Name:UNIVERSITY RADIATION ONCOLOGISTS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DEPARTMENT CHAIR
Authorized Official - Prefix:DR
Authorized Official - First Name:DENNIS
Authorized Official - Middle Name:C
Authorized Official - Last Name:SHRIEVE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:801-581-8793
Mailing Address - Street 1:PO BOX 413031
Mailing Address - Street 2:
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84141-3031
Mailing Address - Country:US
Mailing Address - Phone:801-236-7747
Mailing Address - Fax:
Practice Address - Street 1:1950 EAST CIRCLE OF HOPE
Practice Address - Street 2:STE. 1570
Practice Address - City:SALT LAKE CITY
Practice Address - State:UT
Practice Address - Zip Code:84112-5550
Practice Address - Country:US
Practice Address - Phone:801-581-8793
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-07
Last Update Date:2011-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0001XAllopathic & Osteopathic PhysiciansRadiologyRadiation OncologyGroup - Multi-Specialty
No2085R0203XAllopathic & Osteopathic PhysiciansRadiologyTherapeutic RadiologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
UTCQ2420OtherRAILROAD MEDICARE
UT=========007Medicaid
UT=========007Medicaid