Provider Demographics
NPI:1972503696
Name:UTAH DIGESTIVE HEALTH INSTITUTE
Entity Type:Organization
Organization Name:UTAH DIGESTIVE HEALTH INSTITUTE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING PARTNER
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:E
Authorized Official - Last Name:LOWE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:801-475-5400
Mailing Address - Street 1:6028 S RIDGELINE DR
Mailing Address - Street 2:#201
Mailing Address - City:OGDEN
Mailing Address - State:UT
Mailing Address - Zip Code:84405-6914
Mailing Address - Country:US
Mailing Address - Phone:801-475-5400
Mailing Address - Fax:801-475-8614
Practice Address - Street 1:6028 S RIDGELINE DR
Practice Address - Street 2:#201
Practice Address - City:OGDEN
Practice Address - State:UT
Practice Address - Zip Code:84405-6914
Practice Address - Country:US
Practice Address - Phone:801-475-5400
Practice Address - Fax:801-475-8614
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-07-22
Last Update Date:2008-04-20
Deactivation Date:2005-08-02
Deactivation Code:
Reactivation Date:2007-08-24
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT48268889301001OtherREGENCE BLUE CROSS
UT107006015101OtherIHC
UT=========002Medicaid
C63641Medicare UPIN