Healthcare Provider Details

I. General information

NPI: 1174587984
Provider Name (Legal Business Name): ST MARKS AMBULATORY SURGERY ASSOCIATES LP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/17/2006
Last Update Date: 04/17/2024
Certification Date: 04/17/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1250 E 3900 S SUITE 100
SALT LAKE CITY UT
84124-1348
US

IV. Provider business mailing address

1250 E 3900 S SUITE 100
SALT LAKE CITY UT
84124-1348
US

V. Phone/Fax

Practice location:
  • Phone: 801-262-0358
  • Fax: 801-262-0901
Mailing address:
  • Phone: 801-262-0358
  • Fax: 801-262-0901

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA1903X
TaxonomyAmbulatory Surgical Clinic/Center
License Number2005ASF519
License Number StateUT

VIII. Authorized Official

Name: WILLIAM GREGORY SWINNEY
Title or Position: VP
Credential:
Phone: 972-789-2877