Provider Demographics
NPI:1801181631
Name:UNIVERSITY OF UTAH
Entity Type:Organization
Organization Name:UNIVERSITY OF UTAH
Other - Org Name:DEPT OF NEUROSURGERY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PROFESSOR AND CHAIRMAN
Authorized Official - Prefix:DR
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:T
Authorized Official - Last Name:COULDWELL
Authorized Official - Suffix:
Authorized Official - Credentials:MD, PHD
Authorized Official - Phone:801-581-6908
Mailing Address - Street 1:175 N MEDICAL DR
Mailing Address - Street 2:
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84132-0001
Mailing Address - Country:US
Mailing Address - Phone:801-581-6908
Mailing Address - Fax:801-581-4385
Practice Address - Street 1:175 N MEDICAL DR
Practice Address - Street 2:
Practice Address - City:SALT LAKE CITY
Practice Address - State:UT
Practice Address - Zip Code:84132-0001
Practice Address - Country:US
Practice Address - Phone:801-581-6908
Practice Address - Fax:801-581-4385
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-06-09
Last Update Date:2011-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT190104-3102284300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes284300000XHospitalsSpecial Hospital