Healthcare Provider Details

I. General information

NPI: 1811146384
Provider Name (Legal Business Name): FAMILY SURGICAL SUITE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/09/2008
Last Update Date: 09/09/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

151 E 5600 S STE 104
MURRAY UT
84107-8140
US

IV. Provider business mailing address

PO BOX 2265
SANDY UT
84091-2265
US

V. Phone/Fax

Practice location:
  • Phone: 801-495-1064
  • Fax: 801-523-1139
Mailing address:
  • Phone: 801-495-1064
  • Fax: 801-523-1139

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number
License Number StateUT

VIII. Authorized Official

Name: MRS. DAWN DEHART
Title or Position: ADMIN.
Credential:
Phone: 801-495-1064