Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.

Caresource

Organization Family Medicine Physician · NPI 1124242128

Caresource is a Family Medicine Physician in Salt Lake City, Utah. Licensed in Utah. Registered with an NPI since 2007.

Licensed in
UT
In the registry since
2007
Specialties on file
2

Practice location Address checks out

1624 E 4500 S
Salt Lake City, UT 84117-4212
Phone: (801) 266-7200
Fax: (801) 266-7004
Show map & directions

Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Hospice and Palliative Medicine (Family Medicine) Physician (primary) Taxonomy 207QH0002X · Licence 5221090-1205 (UT)
Family Medicine Physician Taxonomy 207Q00000X · Licence 5221090-1205 (UT)

Record details

NPI number1124242128
Entity typeOrganization (Type 2)
Organization subpartNo
Authorized official Shawntel Tanner — Administrator · (801) 266-7200
Other names Caresource Senior Supportive Care Center
NPI enumeratedApril 12, 2007
Last updated in NPPESSeptember 11, 2025
Mailing address1624 E 4500 S, Salt Lake City, UT 84117-4212

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