Healthcare Provider Details

I. General information

NPI: 1629023858
Provider Name (Legal Business Name): OGDEN ORTHOPAEDIC SPECIALISTS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/24/2006
Last Update Date: 07/08/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4403 HARRISON BLVD SUITE 2600
OGDEN UT
84403
US

IV. Provider business mailing address

4403 HARRISON BLVD SUITE 2600
OGDEN UT
84403
US

V. Phone/Fax

Practice location:
  • Phone: 801-387-2600
  • Fax: 801-387-2625
Mailing address:
  • Phone: 801-387-2600
  • Fax: 801-387-2625

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: VICKIE H ANDERSON
Title or Position: OFFICE MANAGER
Credential:
Phone: 801-387-2618