Healthcare Provider Details

I. General information

NPI: 1558550319
Provider Name (Legal Business Name): CACHE ORTHOPAEDICS PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/17/2007
Last Update Date: 01/18/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2380 N 400 E STE G
LOGAN UT
84341-1749
US

IV. Provider business mailing address

274 N MAIN ST
LOGAN UT
84321-3915
US

V. Phone/Fax

Practice location:
  • Phone: 435-792-4100
  • Fax:
Mailing address:
  • Phone: 435-753-1600
  • Fax: 435-753-9521

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number1654981205
License Number StateUT
# 2
Primary TaxonomyN
Taxonomy Code207XS0106X
TaxonomyOrthopaedic Hand Surgery Physician
License Number1654981205
License Number StateUT
# 3
Primary TaxonomyN
Taxonomy Code207XX0004X
TaxonomyOrthopaedic Foot and Ankle Surgery Physician
License Number1654981205
License Number StateUT
# 4
Primary TaxonomyN
Taxonomy Code207XX0005X
TaxonomySports Medicine (Orthopaedic Surgery) Physician
License Number1654981205
License Number StateUT

VIII. Authorized Official

Name: TRACEY KARTSONE
Title or Position: ACCOUNTS MANAGER
Credential:
Phone: 435-753-1600