MEDICARE: ROSENBERG COOLEY METCALF LC

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy
1	363A00000X	Physician Assistant
2	207XX0005X	Sports Medicine (Orthopaedic Surgery) Physician
3	225100000X	Physical Therapist
4	207X00000X	Orthopaedic Surgery Physician

General Provider Information

NPI Number	:	1902652787
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ROSENBERG COOLEY METCALF LC

Provider Business Mailing Address
First Line	:	900 ROUND VALLEY DR STE 100
Second Line	:
City	:	PARK CITY
State	:	UT
Zip	:	84060-7552
Country	:	US
Telephone Number	:	435-655-6600
Fax Number	:	435-655-2388

Provider Business Practice Location Address
First Line	:	6340 S 3000 E STE 200
Second Line	:
City	:	SALT LAKE CITY
State	:	UT
Zip	:	84121-3552
Country	:	US
Telephone Number	:	801-743-4500
Fax Number	:	435-655-2388

Authorized Official
Title or Position	:	OWNER
Name	:	DR. GARRETT DAVIS
Credential	:	MD
Telephone Number	:	435-655-6600

Provider Enumeration Date	:	04/24/2024
Last Update Date	:	08/28/2024

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