Healthcare Provider Details

I. General information

NPI: 1487895462
Provider Name (Legal Business Name): SEVIER VALLEY ANESTHESIA GROUP, LLP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/20/2009
Last Update Date: 09/14/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1000 N MAIN ST
RICHFIELD UT
84701-1857
US

IV. Provider business mailing address

PO BOX 3750
SALT LAKE CITY UT
84110-3750
US

V. Phone/Fax

Practice location:
  • Phone: 435-893-4100
  • Fax:
Mailing address:
  • Phone: 800-767-0826
  • Fax: 801-432-2670

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number
License Number State

VIII. Authorized Official

Name: REX KNIGHT BELNAP
Title or Position: PRESIDENT
Credential: CRNA
Phone: 800-767-0826