OrganizationActive
Caresource
NPI 1124242128 · Hospice and Palliative Medicine (Family Medicine) Physician · Salt Lake City, UT
Provider details
- NPI number
- 1124242128
- Entity type
- Organization
- Primary specialty
- Hospice and Palliative Medicine (Family Medicine) PhysicianAllopathic & Osteopathic Physicians
- Organization subpart
- No
- Authorized official
- Shawntel Tanner, Administrator(801) 266-7200
- License
- 5221090-1205 (UT)
Specialties & taxonomies
- Hospice and Palliative Medicine (Family Medicine) PhysicianPrimary207QH0002XLicense 5221090-1205 (UT)
Allopathic & Osteopathic Physicians
Allopathic & Osteopathic Physicians
Practice location
1624 E 4500 S
Salt Lake City, UT 84117-4212
Phone: (801) 266-7200
Fax: (801) 266-7004
Approximate (ZIP-level) locationGet directions
Mailing address
1624 E 4500 S
Salt Lake City, UT 84117-4212
Other names (DBA / former)
- Other name
- Caresource Senior Supportive Care Center
Registry dates
- Enumerated
- 2007-04-12
- Last updated
- 2025-09-11
Source: CMS NPPES Data Dissemination (June 2026). NPI Central is not affiliated with CMS. Data is provided as-is from the public registry.