Healthcare Provider Details

I. General information

NPI: 1811954886
Provider Name (Legal Business Name): PHYSICIANS SURGICAL CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/26/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

151 E 5600 S SUITE 104
MURRAY UT
84107-6181
US

IV. Provider business mailing address

PO BOX 2265
SANDY UT
84091-2265
US

V. Phone/Fax

Practice location:
  • Phone: 801-288-1211
  • Fax: 801-685-2242
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 StateUT

VIII. Authorized Official

Name: BRIAN J DEHART
Title or Position: OWNER/PRESIDENT
Credential:
Phone: 801-816-1187