Provider Demographics
NPI:1013520154
Name:UTAH KIDNEY CLINIC LLC
Entity Type:Organization
Organization Name:UTAH KIDNEY CLINIC LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VP OF PHYSICIAN SERVICES
Authorized Official - Prefix:
Authorized Official - First Name:CARYL
Authorized Official - Middle Name:
Authorized Official - Last Name:SCHARPF
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:385-350-8500
Mailing Address - Street 1:4345 HARRISON BLVD STE 101
Mailing Address - Street 2:
Mailing Address - City:OGDEN
Mailing Address - State:UT
Mailing Address - Zip Code:84403-3103
Mailing Address - Country:US
Mailing Address - Phone:385-350-8500
Mailing Address - Fax:385-350-8555
Practice Address - Street 1:4345 HARRISON BLVD STE 101
Practice Address - Street 2:
Practice Address - City:OGDEN
Practice Address - State:UT
Practice Address - Zip Code:84403-3103
Practice Address - Country:US
Practice Address - Phone:385-350-8500
Practice Address - Fax:844-946-0909
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-08-28
Last Update Date:2023-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrologyGroup - Single Specialty