Provider Demographics
NPI:1124102595
Name:WASATCH PEDIATRICS, INC
Entity type:Organization
Organization Name:WASATCH PEDIATRICS, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PROVIDER RELATIONS
Authorized Official - Prefix:
Authorized Official - First Name:ALYSHIA
Authorized Official - Middle Name:
Authorized Official - Last Name:RICE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:801-453-9625
Mailing Address - Street 1:9071 S 1300 W STE 205
Mailing Address - Street 2:
Mailing Address - City:WEST JORDAN
Mailing Address - State:UT
Mailing Address - Zip Code:84088-6725
Mailing Address - Country:US
Mailing Address - Phone:801-453-9625
Mailing Address - Fax:801-944-7347
Practice Address - Street 1:9071 S 1300 W STE 205
Practice Address - Street 2:
Practice Address - City:WEST JORDAN
Practice Address - State:UT
Practice Address - Zip Code:84088-6725
Practice Address - Country:US
Practice Address - Phone:801-453-9625
Practice Address - Fax:801-944-7347
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-24
Last Update Date:2023-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty