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PARK CITY INTERNAL MEDICINE - PEDIATRICS, LC
NPI 1750569562
Clinic/Center - Health Service in Park City, UT

Active since February 04, 2008
1612 UTE BLVD, STE 205, PARK CITY, UT 84098(435) 655-3309(435) 655-3392 Get Directions Write a Review

NPPES record last updated: May 18, 2011. Verified against the NPPES registry weekly; last sync: July 26, 2026.

About Park City Internal Medicine - Pediatrics, Lc NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

PARK CITY INTERNAL MEDICINE - PEDIATRICS, LC (NPI 1750569562) is a healthcare organization registered as a health service in Park City, Utah and active in the NPI registry since February 2008. The organization lists Penny Peacock, Owner, as its authorized official.

NPPES Registry Identity

NPI1750569562
Entity TypeOrganization
Primary Taxonomy261QH0100X
Legal Business NamePARK CITY INTERNAL MEDICINE - PEDIATRICS, LC
Location Address1612 UTE BLVD, STE 205Park City, UT 84098-7500
Mailing Address1612 Ute Blvd, Ste 205Park City, UT 84098-7500 · (435) 655-3309 · Fax (435) 655-3392
Phone(435) 655-3309
Fax(435) 655-3392
Organization SubpartNo
Authorized OfficialPenny PeacockOwner · (435) 655-3309
Enumeration DateFebruary 4, 2008
Last NPPES UpdateMay 18, 2011
✔ NPI 1750569562 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyClinic/Center · Health ServiceAmbulatory Health Care Facilities
Taxonomy Code261QH0100X
License✔ Licensed in UT · 5151398-1205
1612 UTE BLVD, Park City, UT 84098
Open in Google Maps ↗

Other Identifiers 2

Medicaid=========001UT
Medicare PIN000057540UT

Other Providers at the Same Location NPPES 3

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

MR. VIET NGUYEN M.D.
Specialist
1612 UTE BLVD, 112
PARK CITY, UT 84098
Summit County (435) 655-3309
IHC HEALTH SERVICES INC
Clinic/Center (Multi-Specialty)
1612 UTE BLVD, STE 112
PARK CITY, UT 84098
Summit County (801) 507-3500
PENNY JEAN PEACOCK M.D.
Internal Medicine
1612 UTE BLVD, 205
PARK CITY, UT 84098
Summit County (435) 655-3309

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Park City Internal Medicine - Pediatrics, Lc's NPI number?

The NPI number for Park City Internal Medicine - Pediatrics, Lc is 1750569562. It was assigned to this organization in the NPPES registry on February 4, 2008.

Where is Park City Internal Medicine - Pediatrics, Lc located?

Park City Internal Medicine - Pediatrics, Lc is located at 1612 Ute Blvd Ste 205, Park City, UT 84098. The listed phone number is (435) 655-3309.

What is Park City Internal Medicine - Pediatrics, Lc's specialty?

The primary specialty registered for this NPI is Clinic/Center, specializing in Health Service, with taxonomy code 261QH0100X.

When was this NPI record last updated?

The NPPES record for Park City Internal Medicine - Pediatrics, Lc was last updated on May 18, 2011. NPI Profile syncs with the weekly NPPES data releases published by CMS.