MEDICARE: INTERVENTIONAL SURGICAL 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	:	1497451439
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	INTERVENTIONAL SURGICAL CENTER LLC

Provider Business Mailing Address
First Line	:	10376 S JORDAN GTWY
Second Line	:
City	:	SOUTH JORDAN
State	:	UT
Zip	:	84095-3954
Country	:	US
Telephone Number	:	801-816-0332
Fax Number	:	801-816-0331

Provider Business Practice Location Address
First Line	:	151 E 5600 S STE 104
Second Line	:
City	:	MURRAY
State	:	UT
Zip	:	84107-8140
Country	:	US
Telephone Number	:	801-816-0332
Fax Number	:	801-816-0331

Authorized Official
Title or Position	:	ADMINISTRATOR
Name	:	LAURA HILL
Credential	:
Telephone Number	:	801-816-0332

Provider Enumeration Date	:	02/01/2023
Last Update Date	:	03/20/2023

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