Healthcare Provider Details

I. General information

NPI: 1952019846
Provider Name (Legal Business Name): MOUNTAIN ORTHOPAEDICS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/09/2022
Last Update Date: 09/17/2025
Certification Date: 09/17/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1551 RENAISSANCE TOWNE DR STE 500
BOUNTIFUL UT
84010-7678
US

IV. Provider business mailing address

PO BOX 33539
BELFAST ME
04915-0613
US

V. Phone/Fax

Practice location:
  • Phone: 801-295-7200
  • Fax:
Mailing address:
  • Phone: 801-295-7200
  • Fax: 801-295-4930

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code174400000X
TaxonomySpecialist
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number
License Number State

VIII. Authorized Official

Name: CLINT WOOTEN
Title or Position: OWNER/ PHYSICIAN
Credential: MD
Phone: 801-295-7200