Healthcare Provider Details

I. General information

NPI: 1962007757
Provider Name (Legal Business Name): SURGERY CENTER AT GROVE CREEK, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/01/2020
Last Update Date: 12/01/2020
Certification Date: 12/01/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2168 W GROVE PKWY STE 101
PLEASANT GROVE UT
84062-6745
US

IV. Provider business mailing address

2168 W GROVE PKWY STE 101
PLEASANT GROVE UT
84062-6745
US

V. Phone/Fax

Practice location:
  • Phone: 801-772-5050
  • Fax:
Mailing address:
  • Phone: 801-772-5050
  • 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: MR. BRIAN SHELTON
Title or Position: BOARD MEMBER
Credential:
Phone: 801-772-5050