| Advanced Vein And Vascular Of Salt Lake City Llc | |
|
6321 S Redwood Rd Ste 102, Salt Lake City, UT 84123-6799 | |
| (385) 388-8003 | |
| (385) 344-4006 |
| Full Name | Advanced Vein And Vascular Of Salt Lake City Llc |
|---|---|
| Type | Facility |
| Speciality | Internal Medicine - Interventional Cardiology |
| Location | 6321 S Redwood Rd Ste 102, Salt Lake City, Utah |
| Accepts Medicare Assignments | Medicare enrolled and accepts medicare insurance. Providers at this facility may prescribe medicare part D drugs. |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1386272755 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 213ES0103X | Podiatrist - Foot & Ankle Surgery | (* (Not Available)) | Secondary |
| 207RI0011X | Internal Medicine - Interventional Cardiology | (* (Not Available)) | Primary |
| Provider Name | Christopher Yong-ku Kim |
|---|---|
| Provider Type | Practitioner - Cardiovascular Disease (cardiology) |
| Provider Identifiers | NPI Number: 1457650442 PECOS PAC ID: 8820276918 Enrollment ID: I20110620000279 |
| Provider Name | Jennifer Ann Karr |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1417272170 PECOS PAC ID: 4789956632 Enrollment ID: I20170828001694 |
| Provider Name | Charles Scott Needham |
|---|---|
| Provider Type | Practitioner - Thoracic Surgery |
| Provider Identifiers | NPI Number: 1063435899 PECOS PAC ID: 5597796383 Enrollment ID: I20210505000371 |
| Provider Name | Scott Austin Butler |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1366118424 PECOS PAC ID: 5395141741 Enrollment ID: I20210909002565 |
| Provider Name | Calen Powell |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1861072233 PECOS PAC ID: 7618374216 Enrollment ID: I20211116001243 |
| Mailing Address | Practice Location Address |
|---|---|
| Advanced Vein And Vascular Of Salt Lake City Llc 6321 S Redwood Rd Ste 102, Salt Lake City, UT 84123-6799 Ph: (385) 388-8003 | Advanced Vein And Vascular Of Salt Lake City Llc 6321 S Redwood Rd Ste 102, Salt Lake City, UT 84123-6799 Ph: (385) 388-8003 |