Healthcare Provider Details

I. General information

NPI: 1083861165
Provider Name (Legal Business Name): FAMILY SURGICAL SUITE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/20/2008
Last Update Date: 08/20/2008
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

151 E 5600 S STE 104
MURRAY UT
84107-8140
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 Code261QA1903X
TaxonomyAmbulatory Surgical Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: EMILY SAINE
Title or Position: ACCOUNTING
Credential:
Phone: 801-495-1064