Healthcare Provider Details

I. General information

NPI: 1740101385
Provider Name (Legal Business Name): CACHE VALLEY SURGERY CENTER, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/21/2026
Last Update Date: 07/21/2026
Certification Date: 07/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

630 E 1400 N STE 120
LOGAN UT
84341-2549
US

IV. Provider business mailing address

PO BOX 912042
ST GEORGE UT
84791-2042
US

V. Phone/Fax

Practice location:
  • Phone: 435-787-7246
  • Fax: 435-554-7381
Mailing address:
  • Phone: 435-787-7246
  • Fax: 435-554-7381

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number
License Number State

VIII. Authorized Official

Name: ASHLEY PFATENHAUER
Title or Position: CREDENTIALING/CONTRACTING MANAGER
Credential:
Phone: 435-215-0230