Provider Demographics
NPI:1669666509
Name:UTAH HEMATOLOGY ONCOLOGY
Entity Type:Organization
Organization Name:UTAH HEMATOLOGY ONCOLOGY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:C
Authorized Official - Last Name:PITTAM
Authorized Official - Suffix:
Authorized Official - Credentials:MHA
Authorized Official - Phone:801-476-1777
Mailing Address - Street 1:5290 S 400 E
Mailing Address - Street 2:
Mailing Address - City:OGDEN
Mailing Address - State:UT
Mailing Address - Zip Code:84405-7194
Mailing Address - Country:US
Mailing Address - Phone:801-476-1777
Mailing Address - Fax:801-479-1479
Practice Address - Street 1:5405 S 500 E
Practice Address - Street 2:SUITE 202
Practice Address - City:OGDEN
Practice Address - State:UT
Practice Address - Zip Code:84405-6957
Practice Address - Country:US
Practice Address - Phone:801-476-1777
Practice Address - Fax:801-479-1479
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-04
Last Update Date:2014-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT1001556174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT000055993Medicare PIN