Provider Demographics
NPI:1871654459
Name:HEALTH CLINICS OF UTAH-SLC
Entity Type:Organization
Organization Name:HEALTH CLINICS OF UTAH-SLC
Other - Org Name:UTAH DEPARTMENT OF HEALTH
Other - Org Type:Other Name
Authorized Official - Title/Position:CLINIC DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:STEVE
Authorized Official - Middle Name:
Authorized Official - Last Name:IPSEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:801-273-6637
Mailing Address - Street 1:168 N 1950 W STE 201
Mailing Address - Street 2:
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84116-3007
Mailing Address - Country:US
Mailing Address - Phone:801-715-3500
Mailing Address - Fax:801-532-1183
Practice Address - Street 1:168 N 1950 W STE 201
Practice Address - Street 2:
Practice Address - City:SALT LAKE CITY
Practice Address - State:UT
Practice Address - Zip Code:84116-3007
Practice Address - Country:US
Practice Address - Phone:801-715-3500
Practice Address - Fax:801-532-1183
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-13
Last Update Date:2012-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT=========341Medicaid
UT=========341Medicaid