Healthcare Provider Details

I. General information

NPI: 1225954548
Provider Name (Legal Business Name): WASATCH PEAKS ANESTHESIA, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/29/2026
Last Update Date: 06/29/2026
Certification Date: 06/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11762 S STATE ST STE 240
DRAPER UT
84020-7156
US

IV. Provider business mailing address

1246 S 260 W
PAYSON UT
84651-8685
US

V. Phone/Fax

Practice location:
  • Phone: 801-380-8886
  • Fax:
Mailing address:
  • Phone: 801-380-8886
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number
License Number State

VIII. Authorized Official

Name: MR. JARED ROBINSON
Title or Position: ADMINISTRATOR
Credential:
Phone: 801-380-8886