Provider Demographics
NPI:1588656870
Name:UNIVERSITY OF UTAH
Entity Type:Organization
Organization Name:UNIVERSITY OF UTAH
Other - Org Name:UNIVERSITY HEALTH CARE HOSPITALS AND CLINICS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CHIEF FINANCIAL OFFICER
Authorized Official - Prefix:MR
Authorized Official - First Name:CHARLTON
Authorized Official - Middle Name:
Authorized Official - Last Name:PARK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:801-585-1325
Mailing Address - Street 1:PO BOX 511258
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90051-7813
Mailing Address - Country:US
Mailing Address - Phone:801-587-6760
Mailing Address - Fax:801-587-6675
Practice Address - Street 1:50 N MEDICAL DR
Practice Address - Street 2:
Practice Address - City:SALT LAKE CITY
Practice Address - State:UT
Practice Address - Zip Code:84132-0100
Practice Address - Country:US
Practice Address - Phone:801-581-2121
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-08-22
Last Update Date:2023-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT2006-HOSP-208261QD0000X
UT2004-HOSP-208282N00000X
283X00000X
UT3001L3416A0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282N00000XHospitalsGeneral Acute Care Hospital
No261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental
No283X00000XHospitalsRehabilitation Hospital
No3416A0800XTransportation ServicesAmbulanceAir Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT460009Medicare Oscar/Certification
UT000006971Medicare ID - Type UnspecifiedMEDICARE PART B GROUP ID