Provider Demographics
NPI:1366403784
Name:UNIVERSITY HEALTH CARE
Entity type:Organization
Organization Name:UNIVERSITY HEALTH CARE
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PATIENT CARE COORDINATOR
Authorized Official - Prefix:MS
Authorized Official - First Name:ELIZABETH
Authorized Official - Middle Name:KIRTS
Authorized Official - Last Name:SMITH
Authorized Official - Suffix:
Authorized Official - Credentials:MPH, ICCE, HBCE
Authorized Official - Phone:807-581-2896
Mailing Address - Street 1:50 N MEDICAL DR
Mailing Address - Street 2:ROOM AA 119
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84132-0001
Mailing Address - Country:US
Mailing Address - Phone:801-581-2328
Mailing Address - Fax:801-585-3487
Practice Address - Street 1:50 N MEDICAL DR
Practice Address - Street 2:ROOM AA 119
Practice Address - City:SALT LAKE CITY
Practice Address - State:UT
Practice Address - Zip Code:84132-0001
Practice Address - Country:US
Practice Address - Phone:801-581-2328
Practice Address - Fax:801-585-3487
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-03-28
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251K00000XAgenciesPublic Health or Welfare
Provider Identifiers
StateIdentifier IDID TypeIssuer
UTS9446Medicaid