Healthcare Provider Details

I. General information

NPI: 1700656337
Provider Name (Legal Business Name): NORTH OGDEN SURGERY CENTER LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/04/2024
Last Update Date: 01/04/2024
Certification Date: 01/03/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1804 WEST 2550 NORTH
FARR WEST UT
84404
US

IV. Provider business mailing address

2201 FM 1339
KINGSBURY TX
78638-1112
US

V. Phone/Fax

Practice location:
  • Phone: 303-332-4170
  • Fax:
Mailing address:
  • Phone: 303-332-4170
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA1903X
TaxonomyAmbulatory Surgical Clinic/Center
License Number
License Number State

VII. Legacy identifiers

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

VIII. Authorized Official

Name: MS. LISA COX
Title or Position: ADMINISTRATOR
Credential: RN
Phone: 303-332-4170