Healthcare Provider Details

I. General information

NPI: 1619347135
Provider Name (Legal Business Name): UTAH SPINE INSTITUTE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/26/2015
Last Update Date: 09/26/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5801 S FASHION BLVD SUITE 180
MURRAY UT
84107-6159
US

IV. Provider business mailing address

5801 S FASHION BLVD SUITE 180
MURRAY UT
84107-6159
US

V. Phone/Fax

Practice location:
  • Phone: 801-262-7246
  • Fax: 801-262-3442
Mailing address:
  • Phone: 801-262-7246
  • Fax: 801-262-3442

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA1903X
TaxonomyAmbulatory Surgical Clinic/Center
License Number261QA1903X
License Number StateUT

VIII. Authorized Official

Name: DR. VIKAS GARG
Title or Position: MEDICAL DIRECTOR/ OWNER
Credential: M.D, MSA
Phone: 206-225-0724