Healthcare Provider Details

I. General information

NPI: 1164504353
Provider Name (Legal Business Name): SYNERGIES SURGERY CENTER LP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/19/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

348 E 4500 S SUITE 230
SALT LAKE CITY UT
84107-3906
US

IV. Provider business mailing address

348 E 4500 S SUITE 230
SALT LAKE CITY UT
84107-3906
US

V. Phone/Fax

Practice location:
  • Phone: 801-685-6400
  • Fax: 801-685-6401
Mailing address:
  • Phone: 801-685-6400
  • Fax: 801-685-6401

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: DON LIEDTKE
Title or Position: CFO
Credential:
Phone: 615-344-5507