Healthcare Provider Details

I. General information

NPI: 1760939367
Provider Name (Legal Business Name): UTAH VALLEY SURGERY CENTER, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/01/2016
Last Update Date: 02/24/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2168 WEST GROVE PARKWAY SUITE 101
PLEASANT GROVE UT
84062-6711
US

IV. Provider business mailing address

2168 WEST GROVE PARKWAY SUITE 101
PLEASANT GROVE UT
84062-6711
US

V. Phone/Fax

Practice location:
  • Phone: 801-772-5050
  • Fax:
Mailing address:
  • Phone: 435-650-5291
  • Fax:

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: DR. STAN PHILLIPS
Title or Position: CEO
Credential: DPM
Phone: 801-772-5050