Provider Demographics
NPI:1134393499
Name:CITY CREEK MEDICAL SPECIALISTS, INC
Entity type:Organization
Organization Name:CITY CREEK MEDICAL SPECIALISTS, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ANN
Authorized Official - Middle Name:
Authorized Official - Last Name:JEFFERDS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:801-408-5151
Mailing Address - Street 1:324 TENTH AVE
Mailing Address - Street 2:SUITE 160
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84103-2853
Mailing Address - Country:US
Mailing Address - Phone:801-408-5151
Mailing Address - Fax:801-408-3598
Practice Address - Street 1:UNIV OF UTAH MEDICAL HOSPITAL 50 NORTH DR
Practice Address - Street 2:
Practice Address - City:SALT LAKE CITY
Practice Address - State:UT
Practice Address - Zip Code:84132-2853
Practice Address - Country:US
Practice Address - Phone:801-581-2121
Practice Address - Fax:801-408-3598
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-17
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT56382771205174400000X
UT1737701205174400000X
UT5740231205174400000X
UT1816141205174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Multi-Specialty