Healthcare Provider Details

I. General information

NPI: 1366077273
Provider Name (Legal Business Name): NPH ANESTHESIA OF UTAH, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/11/2020
Last Update Date: 08/20/2025
Certification Date: 08/20/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5475 S 500 E
OGDEN UT
84405-6905
US

IV. Provider business mailing address

2221 LAKESIDE BLVD STE 600
RICHARDSON TX
75082-4416
US

V. Phone/Fax

Practice location:
  • Phone: 469-505-1609
  • Fax:
Mailing address:
  • Phone: 972-422-5941
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number
License Number State

VIII. Authorized Official

Name: LATRICIA SMITH
Title or Position: PAYER ENROLLMENT SUPERVISOR
Credential:
Phone: 972-761-5509