Healthcare Provider Details

I. General information

NPI: 1497451439
Provider Name (Legal Business Name): INTERVENTIONAL SURGICAL CENTER LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/01/2023
Last Update Date: 03/20/2023
Certification Date: 03/20/2023
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

10376 S JORDAN GTWY
SOUTH JORDAN UT
84095-3954
US

V. Phone/Fax

Practice location:
  • Phone: 801-816-0332
  • Fax: 801-816-0331
Mailing address:
  • Phone: 801-816-0332
  • Fax: 801-816-0331

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: LAURA HILL
Title or Position: ADMINISTRATOR
Credential:
Phone: 801-816-0332