Healthcare Provider Details

I. General information

NPI: 1962045096
Provider Name (Legal Business Name): SUMMIT BRAIN AND SPINE PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/22/2019
Last Update Date: 01/15/2026
Certification Date: 01/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3000 N TRIUMPH BLVD STE 330
LEHI UT
84043-7188
US

IV. Provider business mailing address

3000 N TRIUMPH BLVD STE 330
LEHI UT
84043-7188
US

V. Phone/Fax

Practice location:
  • Phone: 385-345-3560
  • Fax: 877-331-0467
Mailing address:
  • Phone: 385-345-3560
  • Fax: 877-331-0467

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207T00000X
TaxonomyNeurological Surgery Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number
License Number State

VIII. Authorized Official

Name: JOHN RYAN EDWARDS
Title or Position: NEUROSURGEON
Credential: MD
Phone: 385-345-3560