Provider Demographics
NPI:1760713523
Name:HEART AND LUNG INSTITUTE OF UTAH INC
Entity Type:Organization
Organization Name:HEART AND LUNG INSTITUTE OF UTAH INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF OPERATING OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:TYLER
Authorized Official - Middle Name:R
Authorized Official - Last Name:WILKO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:801-263-2370
Mailing Address - Street 1:5979 S FASHION BLVD
Mailing Address - Street 2:
Mailing Address - City:MURRAY
Mailing Address - State:UT
Mailing Address - Zip Code:84107-7364
Mailing Address - Country:US
Mailing Address - Phone:801-263-2370
Mailing Address - Fax:801-265-1200
Practice Address - Street 1:5979 SO. FASHION BLVD
Practice Address - Street 2:
Practice Address - City:MURRAY
Practice Address - State:UT
Practice Address - Zip Code:84107-7364
Practice Address - Country:US
Practice Address - Phone:801-263-2370
Practice Address - Fax:801-265-1200
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:HEART AND LUNG INSTITUTE OF UTAH INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2010-01-19
Last Update Date:2018-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RS0012XAllopathic & Osteopathic PhysiciansInternal MedicineSleep MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
U000004622Medicare PIN