Healthcare Provider Details

I. General information

NPI: 1568285096
Provider Name (Legal Business Name): OGDEN ENDOSCOPY CENTER LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/04/2024
Last Update Date: 11/25/2025
Certification Date: 11/25/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3903 MEDICAL DR STE 400
OGDEN UT
84403-2316
US

IV. Provider business mailing address

3903 MEDICAL DR STE 400
OGDEN UT
84403-2316
US

V. Phone/Fax

Practice location:
  • Phone: 385-732-1904
  • Fax: 385-298-4017
Mailing address:
  • Phone: 385-732-1904
  • Fax: 385-298-4017

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: JEREMY PETERS
Title or Position: AP STRATEGIC PARTNERSHIP
Credential:
Phone: 303-813-5160