Healthcare Provider Details

I. General information

NPI: 1548754427
Provider Name (Legal Business Name): UNION PARK SURGICAL CENTER LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/14/2018
Last Update Date: 06/14/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7001 S 900 E STE 100
MIDVALE UT
84047-1700
US

IV. Provider business mailing address

2075 E KENSINGTON AVE
SALT LAKE CITY UT
84108-2627
US

V. Phone/Fax

Practice location:
  • Phone: 801-656-6521
  • Fax:
Mailing address:
  • Phone:
  • 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: MR. ROBERT THOMAS HARRISON
Title or Position: MANAGER
Credential:
Phone: 801-656-6521