Healthcare Provider Details

I. General information

NPI: 1154979284
Provider Name (Legal Business Name): EPIC SURGICAL LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/02/2019
Last Update Date: 01/30/2020
Certification Date: 01/30/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5450 S GREEN ST STE B
MURRAY UT
84123-5632
US

IV. Provider business mailing address

5450 S GREEN ST STE B
MURRAY UT
84123-5632
US

V. Phone/Fax

Practice location:
  • Phone: 12-906-0608
  • Fax:
Mailing address:
  • Phone: 12-906-0608
  • Fax:

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: DR. MARK SCOTT HUFF
Title or Position: CMO & CEO
Credential: MD
Phone: 801-663-3332