Healthcare Provider Details

I. General information

NPI: 1710813282
Provider Name (Legal Business Name): RIDGELINE ORTHOPEDIC SPECIALISTS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/22/2026
Last Update Date: 06/29/2026
Certification Date: 06/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

700 W 800 N STE 100
OREM UT
84057-6301
US

IV. Provider business mailing address

700 W 800 N STE 100
OREM UT
84057-6301
US

V. Phone/Fax

Practice location:
  • Phone: 435-986-9369
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207XS0106X
TaxonomyOrthopaedic Hand Surgery Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207XX0004X
TaxonomyOrthopaedic Foot and Ankle Surgery Physician
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number
License Number State

VIII. Authorized Official

Name: AJ YERGENSEN
Title or Position: ADMIN
Credential:
Phone: 435-986-9369