Provider Demographics
NPI:1013954411
Name:HEART AND LUNG INSTITUTE OF UTAH INC
Entity Type:Organization
Organization Name:HEART AND LUNG INSTITUTE OF UTAH INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:COO
Authorized Official - Prefix:
Authorized Official - First Name:TYLER
Authorized Official - Middle Name:K
Authorized Official - Last Name:WILKO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:801-263-2370
Mailing Address - Street 1:PO BOX 847112
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75284-7112
Mailing Address - Country:US
Mailing Address - Phone:801-263-2370
Mailing Address - Fax:801-265-1200
Practice Address - Street 1:5979 FASHION BLVD
Practice Address - Street 2:
Practice Address - City:MURRAY
Practice Address - State:UT
Practice Address - Zip Code:84107-7364
Practice Address - Country:US
Practice Address - Phone:801-263-2370
Practice Address - Fax:801-265-1200
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-02
Last Update Date:2014-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Multi-Specialty
No207RC0200XAllopathic & Osteopathic PhysiciansInternal MedicineCritical Care MedicineGroup - Multi-Specialty
No207RI0011XAllopathic & Osteopathic PhysiciansInternal MedicineInterventional CardiologyGroup - Multi-Specialty
No207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary DiseaseGroup - Multi-Specialty
No207RS0012XAllopathic & Osteopathic PhysiciansInternal MedicineSleep MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT1811954191Medicaid
UT1811954191Medicaid