NPI age
9 years
Enumerated 2017-01-12
● Active Type 2 · Organization
Subpart
University Of Utah Pediatric Services
University Of Utah Pediatric Services is 1 of 5 psychiatry & neurology organizations in Idaho.
Primary specialty
Psychiatry & Neurology
Plus 1 secondary
Practice locations
1
0 secondary on file
Status
Active
No deactivations on record
Authorized official
Clark
Department Chair
Last NPPES update
2020-05-21
Source: monthly bulk 2026-05
How this organization compares
Across 5 active psychiatry & neurology providers in Idaho.
NPI age
9 years
↓ 9 yr below median
Practice locations
1
0 secondary on file
Subspecialties
1
In the 80% of peers with subspecialties
NPI lifetime · 2017 → 2026
2017-01Enumerated in NPPES
2017
2026
Where they practice
Primary practice location
1645 Pancheri Dr
Idaho Falls, ID 834023169
Mailing address
Po Box 841450
Los Angeles, CA 900841450
Authorized official
Edward Clark, MD
Department Chair
📞 8015876336
Specialties
-
Psychiatry & Neurology PrimaryA Child Neurologist specializes in neurology with special skills in diagnosis and treatment of neurologic disorders of the neonatal period, infancy, early childhood, and adolescence.
-
PediatricsA pediatrician is concerned with the physical, emotional and social health of children from birth to young adulthood. Care encompasses a broad spectrum of health services ranging from preventive healthcare to the diagnosis and treatment...
Other names on file (2)
Doing-business-as, former, and alternate names recorded by NPPES.
-
Pediatric Neurology - Idaho Falls
-
Pediatric Neurology - Idaho Falls
Practice context
Single-site organization. Only one practice location on file.
Subpart of University Of Utah Pediatric Services.
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- Confirm the NPI on NPPES.The CMS registry is the system of record. Open NPPES →
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