Provider Demographics
NPI:1669502456
Name:UNIVERSITY OF UTAH STUDENT HEALTH CENTER
Entity Type:Organization
Organization Name:UNIVERSITY OF UTAH STUDENT HEALTH CENTER
Other - Org Name:STUDENT HEALTH CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:JOAN
Authorized Official - Middle Name:C
Authorized Official - Last Name:RAWLINS
Authorized Official - Suffix:
Authorized Official - Credentials:MPA
Authorized Official - Phone:801-581-6560
Mailing Address - Street 1:555 FOOTHILL DR # 1
Mailing Address - Street 2:
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84112-1106
Mailing Address - Country:US
Mailing Address - Phone:801-581-6431
Mailing Address - Fax:801-585-5294
Practice Address - Street 1:555 FOOTHILL DR # 1
Practice Address - Street 2:
Practice Address - City:SALT LAKE CITY
Practice Address - State:UT
Practice Address - Zip Code:84112-1106
Practice Address - Country:US
Practice Address - Phone:801-581-6431
Practice Address - Fax:801-585-5294
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-07
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QS1000XAmbulatory Health Care FacilitiesClinic/CenterStudent Health