Provider Demographics
NPI:1811093453
Name:UTAH HEART CLINIC. LC
Entity type:Organization
Organization Name:UTAH HEART CLINIC. LC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:M.D./PARTNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:LEE
Authorized Official - Last Name:BURKE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:801-507-3500
Mailing Address - Street 1:5169 S COTTONWOOD
Mailing Address - Street 2:BUILDING B SUITE 510
Mailing Address - City:MURRAY
Mailing Address - State:UT
Mailing Address - Zip Code:84107-5701
Mailing Address - Country:US
Mailing Address - Phone:801-507-3500
Mailing Address - Fax:801-507-3550
Practice Address - Street 1:5169 S COTTONWOOD
Practice Address - Street 2:BUILDING B SUITE 510
Practice Address - City:MURRAY
Practice Address - State:UT
Practice Address - Zip Code:84107-5701
Practice Address - Country:US
Practice Address - Phone:801-507-3500
Practice Address - Fax:801-507-3550
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-14
Last Update Date:2008-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT19800341207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CQ2137OtherRR MEDICARE
CQ2137OtherRR MEDICARE
NVV100427Medicare PIN
CQ2137OtherRR MEDICARE
ID1368840Medicare PIN