Provider Demographics
NPI:1972185288
Name:AETNA HEALTH OF UTAH INC.
Entity Type:Organization
Organization Name:AETNA HEALTH OF UTAH INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SR PROJECT MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:COLLEEN
Authorized Official - Middle Name:
Authorized Official - Last Name:ALEXANDER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:602-228-5051
Mailing Address - Street 1:4500 E COTTON CENTER BLVD
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85040-8840
Mailing Address - Country:US
Mailing Address - Phone:602-659-1100
Mailing Address - Fax:
Practice Address - Street 1:10150 S CENTENNIAL PKWY
Practice Address - Street 2:
Practice Address - City:SANDY
Practice Address - State:UT
Practice Address - Zip Code:84070-4103
Practice Address - Country:US
Practice Address - Phone:602-659-1100
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-04-26
Last Update Date:2021-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes302R00000XManaged Care OrganizationsHealth Maintenance Organization