Provider Demographics
NPI:1962729293
Name:UNIVERSITY OF UTAH HOSPITAL
Entity type:Organization
Organization Name:UNIVERSITY OF UTAH HOSPITAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CREDENTIALING PROJECT COORDINATOR
Authorized Official - Prefix:
Authorized Official - First Name:BREANNA
Authorized Official - Middle Name:
Authorized Official - Last Name:STROLL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:801-581-2401
Mailing Address - Street 1:838 E SOUTH TEMPLE APT 406
Mailing Address - Street 2:
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84102-1346
Mailing Address - Country:US
Mailing Address - Phone:801-712-1902
Mailing Address - Fax:
Practice Address - Street 1:838 E SOUTH TEMPLE APT 406
Practice Address - Street 2:
Practice Address - City:SALT LAKE CITY
Practice Address - State:UT
Practice Address - Zip Code:84102-1346
Practice Address - Country:US
Practice Address - Phone:801-712-1902
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-04-26
Last Update Date:2010-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory