GENESIS VASCULAR OF SALT LAKE, LLC
NPI 1104361591
Internal Medicine - Interventional Cardiology in Salt Lake City, UT
NPI Status: Active since December 21, 2016
Contact Information
6321 S REDWOOD RD
SUITE 102
SALT LAKE CITY, UT
ZIP 84123
Phone: (385) 388-8003
Fax: (385) 344-4006
- Organization
- Internal Medicine
- Interventional Cardiology
- CLIA Number: 46D2239172
- CLIA Cert. Type: Independent
- CLIA Exp. Date: 09-16-2027
About GENESIS VASCULAR OF SALT LAKE, LLC
This page provides the complete NPI Profile along with additional information for Genesis Vascular Of Salt Lake, Llc, an internist established in Salt Lake City, Utah operating as a Internal Medicine, focusing in interventional cardiology . The healthcare provider is registered in the NPI registry with number 1104361591 assigned on December 2016. The practitioner's primary taxonomy code is 207RI0011X. The provider is registered as an organization and their NPI record was last updated 6 years ago. The organization operates as a Single Specialty Group with one or more individual practitioners, all of who practice with the same area of specialization. The provider's is doing business as Genesis Vascular Of Salt Lake, Llc. The authorized official of this NPI record is Dennis Munford (Manager)
- NPI
- 1104361591
- Provider Legal Name
- GENESIS VASCULAR OF SALT LAKE
- Other Organization Name
- GENESIS VASCULAR OF SALT LAKE, LLC
- Other Name Type
- Doing Business As (3)
- Entity Type
- Organization
- Location Address
- 6321 S REDWOOD RD SUITE 102 SALT LAKE CITY, UT 84123
- Location Phone
- (385) 388-8003
- Location Fax
- (385) 344-4006
- Mailing Address
- 6321 S REDWOOD RD STE 102 TAYLORSVILLE, UT 84123
- Mailing Phone
- (385) 388-8003
- Mailing Fax
- (385) 344-4006
- Is Sole Proprietor?
- No
- Is Organization Subpart?
- Yes
- Enumeration Date
- 12-21-2016
- Last Update Date
- 10-07-2020
- Code Navigator
An internist like Genesis Vascular Of Salt Lake, Llc is a physician who has completed an internal medicine residency and is board-certified or board-eligible in an internist specialty. Internists are trained to care for adults of all ages for many different medical conditions. An internist typically monitors chronic physical conditions, identifies acute diseases, provides family planning, provides counseling about wellness and disease prevention, etc.
Location Map
Specialty - Primary Taxonomy
The NPI enumerator requires providers to submit at least one taxonomy code. A taxonomy code is a unique 10-character code that describes the healthcare provider type, classification, and the area of specialization. There could be only one primary taxonomy code per NPI record. For individual NPIs the license data is associated to the taxonomy code.
- Classification
Internal Medicine Interventional Cardiology
- Taxonomy Code
- 207RI0011X
- Type
- Allopathic & Osteopathic Physicians
- Taxonomy Description
- An area of medicine within the subspecialty of cardiology, which uses specialized imaging and other diagnostic techniques to evaluate blood flow and pressure in the coronary arteries and chambers of the heart and uses technical procedures and medications to treat abnormalities that impair the function of the cardiovascular system.
Secondary Taxonomies
The provider has reported to the NPI enumerator additional taxonomy codes. Multiple taxonomy codes may represent subspecialties or other areas of specialization the provider maybe licensed to practice.
| No. | Taxonomy Code | Type | Classification / Specialization |
License No. (State) |
|---|---|---|---|---|
| 1 | 2085R0204X | Allopathic & Osteopathic Physicians | Radiology | |
| 2 | 2086S0129X | Allopathic & Osteopathic Physicians | Surgery |
Group Taxonomy 193400000X MULTIPLE SINGLE SPECIALTY GROUP
This provdier is a business group of one or more individual practitioners, all of who practice with the same area of specialization.
CLIA Information
The Clinical Laboratory Improvement Amendments (CLIA) of 1988 applies to facilities or sites that test human specimens for health assessment or to diagnose, prevent, or treat disease. The CLIA Program sets standards for clinical laboratory testing and issues certificates. The NPI / CLIA crosswalk information for this NPI number is:
- CLIA Number
- 46D2239172
- Facility Type
- Independent
- Certificate Effective Date
- September 17, 2025
- Certificate Expiration Date
- September 16, 2027
- Laboratory Director
- DR. GHAITH ALTAWALLBEH
- Certificate Type
- Certificate of Accreditation
- Certificate Type Description
- This is a CLIA certificate is issued to Genesis Vascular Of Salt Lake, Llc on the basis of the laboratory's accreditation by an accreditation organization approved by CMS. This type of certificate is issued to a laboratories tha perform nonwaived (moderate and/or high complexity) testing.
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NPI NPI Number Validation
How NPI Validation Works
The NPI validation process uses the ISO-standard Luhn algorithm, a mathematical "handshake", to ensure that a provider's 10-digit ID is authentic and free of common typing errors.
To verify the NPI 1104361591, we treat the final digit (1) as the Check Digit—the target answer we need to reach. The process begins by taking the first nine digits and adding a constant value of 24, which accounts for the "80840" prefix required for all U.S. health identifiers. We then double every other digit starting from the right and sum the individual digits of those results together. For this specific NPI, that total comes to 59. The final step is to find the difference between that total and the next multiple of ten (60 - 59 = 1).
Digit-by-digit view
Use the first nine digits for the calculation. Starting from the right, double every other digit. The last digit is the check digit and is not part of the calculation.
Step 1: Double every other digit from the right
Starting with the rightmost digit of the first nine digits, double every other value. If doubling creates a two-digit number, add those digits together.
Step 2: Add all digits plus the NPI constant
Add the transformed values, the unchanged digits, and the constant 24.
Step 3: Find the amount needed to reach the next multiple of 10
The next multiple of ten after 59 is 60. The difference is the calculated check digit.
Other Providers at the Same Location
The following 10 providers are registered at the same or a nearby location.
TAYLORSVILLE, UT 84123
TAYLORSVILLE, UT 84123
TAYLORSVILLE, UT 84123
Frequently Asked Questions
The NPI number assigned to this healthcare provider is 1104361591, enumerated as an "organization" on December 21, 2016.
The provider is located at 6321 S REDWOOD RD SUITE 102 SALT LAKE CITY, UT 84123 and the phone number is (385) 388-8003.
Internal Medicine with taxonomy code 207RI0011X and a focus in Interventional Cardiology.
