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Contact Information

DERMATOLOGY CENTER OF SALT LAKE INC.
7396 UNION PARK AVE
#201
MIDVALE, UT84047-6700
 Phone: 801-567-1400
 Fax: 801-567-1777
 Website:
 

Specialty

Taxonomy Code Specialty Code Provider Type

Specialist

174400000X
Indicates primary specialty

NPI Profile & details for DERMATOLOGY CENTER OF SALT LAKE INC.

NPI # 1689635799
LBN Legal business name DERMATOLOGY CENTER OF SALT LAKE INC.
Authorized official JOSEPH JENSEN - (MD/OWNER)
Entity Organization
Organization subpart 1 No
Enumeration date 03/29/2006
Last updated 04/15/2019 - About 7 years ago
Identifiers
UT License # 266561-1205
UT Medicaid 528986681031
Other 107007222102 IHC
UT Other QM0000046926 ALTIUS
UT Other 52898668108001 BLUE SHIELD
1 Some organization health care providers are made up of components that furnish different types of health care or have separate physical locations where health care is furnished. These components and physical locations are not themselves legal entities, but are part of the organization health care provider (which is a legal entity). A covered organization provider may decide that its subparts (if it has any) should have their own NPI numbers. If a subpart conducts any HIPAA standard transactions on its own (e.g., separately from its parent), it must obtain its own NPI number.

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