Provider Demographics
NPI:1841171790
Name:JED VANDENBERGHE MD PC
Entity type:Organization
Organization Name:JED VANDENBERGHE MD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JED
Authorized Official - Middle Name:
Authorized Official - Last Name:VANDENBERGHE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:801-278-4693
Mailing Address - Street 1:PO BOX 150610
Mailing Address - Street 2:
Mailing Address - City:OGDEN
Mailing Address - State:UT
Mailing Address - Zip Code:84415-0610
Mailing Address - Country:US
Mailing Address - Phone:801-476-9200
Mailing Address - Fax:801-476-9208
Practice Address - Street 1:2160 E 4500 S STE 1
Practice Address - Street 2:
Practice Address - City:SALT LAKE CITY
Practice Address - State:UT
Practice Address - Zip Code:84117-4010
Practice Address - Country:US
Practice Address - Phone:801-278-4693
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-09-09
Last Update Date:2025-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty