MEDICARE: WASATCH FRONT SURGERY CENTER LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QA1903X	Ambulatory Surgical Clinic/Center

General Provider Information

NPI Number	:	1063720365
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	WASATCH FRONT SURGERY CENTER LLC

Provider Business Mailing Address
First Line	:	3715 W 4100 S
Second Line	:
City	:	WEST VALLEY CITY
State	:	UT
Zip	:	84120-5537
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	3715 W 4100 S
Second Line	:
City	:	WEST VALLEY CITY
State	:	UT
Zip	:	84120-5537
Country	:	US
Telephone Number	:	801-417-1010
Fax Number	:

Authorized Official
Title or Position	:	VP
Name	:	WILLIAM GREGORY SWINNEY
Credential	:
Telephone Number	:	972-789-2877

Provider Enumeration Date	:	09/21/2010
Last Update Date	:	04/06/2018

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