Healthcare Provider Details

I. General information

NPI: 1033503420
Provider Name (Legal Business Name): SPRING CREEK SURGICAL CENTER, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/24/2015
Last Update Date: 03/24/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

65 NORTH GATEWAY DRIVE, SUITE 3
PROVIDENCE UT
84332
US

IV. Provider business mailing address

65 NORTH GATEWAY DRIVE, SUITE 3
PROVIDENCE UT
84332
US

V. Phone/Fax

Practice location:
  • Phone: 435-213-6563
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name: STANTON C. ALLEN
Title or Position: MANAGER
Credential: DDS
Phone: 435-213-6563