Healthcare Provider Details

I. General information

NPI: 1194815639
Provider Name (Legal Business Name): CEDAR ORTHOPAEDIC SURGERY CENTER, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/13/2006
Last Update Date: 12/06/2021
Certification Date: 12/06/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1335 NORTHFIELD RD STE 150
CEDAR CITY UT
84721-9390
US

IV. Provider business mailing address

1335 NORTHFIELD RD STE 150
CEDAR CITY UT
84721-9390
US

V. Phone/Fax

Practice location:
  • Phone: 435-586-5131
  • Fax: 435-865-9874
Mailing address:
  • Phone: 435-586-5131
  • Fax: 435-865-9874

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA1903X
TaxonomyAmbulatory Surgical Clinic/Center
License Number2017-ASF-62751
License Number StateUT

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier1194815639
Identifier TypeMEDICAID
Identifier StateUT
Identifier Issuer

VIII. Authorized Official

Name: JENNIFER PARRY
Title or Position: ADMINISTRATOR
Credential:
Phone: 435-586-5131