Healthcare Provider Details

I. General information

NPI: 1568590743
Provider Name (Legal Business Name): OGDEN ORTHOPAEDIC SPECIALISTS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/01/2007
Last Update Date: 04/10/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6112 S 1550 E SUITE 202
OGDEN UT
84405-5608
US

IV. Provider business mailing address

6112 S 1550 E SUITE 202
OGDEN UT
84405-5608
US

V. Phone/Fax

Practice location:
  • Phone: 801-479-9860
  • Fax: 801-476-8821
Mailing address:
  • Phone: 801-479-9860
  • Fax: 801-476-8821

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number
License Number State

VIII. Authorized Official

Name: JACK W CROSLAND
Title or Position: PRESIDENT
Credential:
Phone: 801-479-9860