Healthcare Provider Details

I. General information

NPI: 1528453396
Provider Name (Legal Business Name): SOUTH POINTE SURGICAL CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/30/2015
Last Update Date: 04/06/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

810 S 100 W SUITE 120
LOGAN UT
84321-5929
US

IV. Provider business mailing address

810 S 100 W SUITE 120
LOGAN UT
84321-5929
US

V. Phone/Fax

Practice location:
  • Phone: 435-752-2020
  • Fax: 435-787-7203
Mailing address:
  • Phone: 435-752-2020
  • Fax: 435-787-7203

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: DR. MATTHEW D HAMMOND
Title or Position: MEMBER
Credential: M.D.
Phone: 435-752-2020