Provider Demographics
NPI:1881001378
Name:UNIVERSITY OF UTAH STUDENT HEALTH CENTER
Entity Type:Organization
Organization Name:UNIVERSITY OF UTAH STUDENT HEALTH CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:W
Authorized Official - Last Name:PERSHING
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:801-581-6431
Mailing Address - Street 1:555 FOOTHILL DR # DR1
Mailing Address - Street 2:
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84112-1106
Mailing Address - Country:US
Mailing Address - Phone:801-581-6431
Mailing Address - Fax:
Practice Address - Street 1:555 FOOTHILL DR # DR1
Practice Address - Street 2:
Practice Address - City:SALT LAKE CITY
Practice Address - State:UT
Practice Address - Zip Code:84112-1106
Practice Address - Country:US
Practice Address - Phone:801-581-6431
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:UNIVERSITY OF UTAH
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2014-07-16
Last Update Date:2014-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QS1000XAmbulatory Health Care FacilitiesClinic/CenterStudent Health