Healthcare Provider Details

I. General information

NPI: 1235382276
Provider Name (Legal Business Name): SANCURO WOUND CARE SYSTEMS, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/03/2008
Last Update Date: 05/04/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5097 S 900 E STE. 200
SALT LAKE CITY UT
84117-5768
US

IV. Provider business mailing address

5097 S 900 E STE. 200
SALT LAKE CITY UT
84117-5768
US

V. Phone/Fax

Practice location:
  • Phone: 801-944-6000
  • Fax: 801-816-1426
Mailing address:
  • Phone: 801-944-6000
  • Fax: 801-816-1426

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207PE0005X
TaxonomyUndersea and Hyperbaric Medicine (Emergency Medicine) Physician
License Number
License Number State

VIII. Authorized Official

Name: NATHAN GINES
Title or Position: VICE PRESIDENT OF OPERATIONS
Credential:
Phone: 801-864-1242