Healthcare Provider Details

I. General information

NPI: 1588401384
Provider Name (Legal Business Name): UTAH ORTHOPAEDIC SPECIALISTS, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/10/2024
Last Update Date: 07/10/2024
Certification Date: 07/10/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5316 S WOODROW ST STE 200
MURRAY UT
84107-5479
US

IV. Provider business mailing address

5316 S WOODROW ST STE 200
MURRAY UT
84107-5479
US

V. Phone/Fax

Practice location:
  • Phone: 801-747-1020
  • Fax:
Mailing address:
  • Phone: 801-747-1020
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number
License Number State

VIII. Authorized Official

Name: KATIE BENARD
Title or Position: PRACTICE ADMINISTRATOR
Credential:
Phone: 801-747-1020