Healthcare Provider Details

I. General information

NPI: 1497938005
Provider Name (Legal Business Name): COMPREHENSIVE ORTHOPEDIC SPECIALISTS, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/06/2007
Last Update Date: 03/17/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

82 S 1100 E SUITE 303
SALT LAKE CITY UT
84102-1686
US

IV. Provider business mailing address

82 S 1100 E SUITE 303
SALT LAKE CITY UT
84102-1686
US

V. Phone/Fax

Practice location:
  • Phone: 801-533-2002
  • Fax: 801-323-9546
Mailing address:
  • Phone: 801-533-2002
  • Fax: 801-323-9546

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number159665-1205
License Number StateUT

VIII. Authorized Official

Name: MERILYN HARRIS
Title or Position: OFFICE MANAGER
Credential:
Phone: 801-505-5300