Healthcare Provider Details

I. General information

NPI: 1053243444
Provider Name (Legal Business Name): SALT LAKE ORTHOPAEDIC SPECIALIST, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/01/2026
Last Update Date: 06/01/2026
Certification Date: 06/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

861 N 980 W
OREM UT
84057-7710
US

IV. Provider business mailing address

PO BOX 30015 DEPT 379
SALT LAKE CTY UT
84130
US

V. Phone/Fax

Practice location:
  • Phone: 801-829-7246
  • Fax: 801-655-9615
Mailing address:
  • Phone: 801-505-0821
  • Fax: 801-505-0803

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2081P2900X
TaxonomyPain Medicine (Physical Medicine & Rehabilitation) Physician
License Number
License Number State

VIII. Authorized Official

Name: BRENT A FELIX
Title or Position: MD/OWNER
Credential:
Phone: 801-284-8626