Provider Demographics
NPI:1669683579
Name:UNIVERSITY HEALTH CARE
Entity Type:Organization
Organization Name:UNIVERSITY HEALTH CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:M.D.
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:WILDER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:801-585-2003
Mailing Address - Street 1:UNIVERSITY OF UTAH HEALTH SCIENCES CTR
Mailing Address - Street 2:50 NORTH MEDICAL DRIVE
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84132-0001
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:30 N 1900 E # 3R210
Practice Address - Street 2:
Practice Address - City:SALT LAKE CITY
Practice Address - State:UT
Practice Address - Zip Code:84132-2305
Practice Address - Country:US
Practice Address - Phone:801-585-2033
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-24
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT6353516-1205261QM1300X
UT6353516-8905282N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-Specialty
Not Answered282N00000XHospitalsGeneral Acute Care Hospital