Provider Demographics
NPI:1861012031
Name:GALLAGHER PEDIATRICS
Entity Type:Organization
Organization Name:GALLAGHER PEDIATRICS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:DR
Authorized Official - First Name:EILEEN
Authorized Official - Middle Name:
Authorized Official - Last Name:GALLAGHER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:415-533-8138
Mailing Address - Street 1:1441 UTE BLVD STE 220
Mailing Address - Street 2:
Mailing Address - City:PARK CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84098-7636
Mailing Address - Country:US
Mailing Address - Phone:435-602-0187
Mailing Address - Fax:435-355-3734
Practice Address - Street 1:1441 UTE BLVD STE 220
Practice Address - Street 2:
Practice Address - City:PARK CITY
Practice Address - State:UT
Practice Address - Zip Code:84098-7636
Practice Address - Country:US
Practice Address - Phone:435-602-0187
Practice Address - Fax:435-355-3734
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-04-17
Last Update Date:2022-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty
No261Q00000XAmbulatory Health Care FacilitiesClinic/CenterGroup - Single Specialty