Healthcare Provider Details

I. General information

NPI: 1043643877
Provider Name (Legal Business Name): UBMC ANESTHESIOLOGY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/15/2013
Last Update Date: 08/15/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

250 W 300 N
ROOSEVELT UT
84066-2336
US

IV. Provider business mailing address

PO BOX 3750
SALT LAKE CITY UT
84110-3750
US

V. Phone/Fax

Practice location:
  • Phone: 801-432-2600
  • Fax: 801-676-5962
Mailing address:
  • Phone: 801-432-2600
  • Fax: 801-676-5962

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: MR. TRENT BELL
Title or Position: GROUP PRESIDENT
Credential: CRNA
Phone: 801-432-2600