Healthcare Provider Details

I. General information

NPI: 1487616793
Provider Name (Legal Business Name): SALT LAKE SURGICAL CENTER LP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/03/2006
Last Update Date: 05/28/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

617 E 3900 S
SALT LAKE CITY UT
84107-1901
US

IV. Provider business mailing address

617 E 3900 S
SALT LAKE CITY UT
84107-1901
US

V. Phone/Fax

Practice location:
  • Phone: 801-261-3141
  • Fax:
Mailing address:
  • Phone: 801-261-3141
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA1903X
TaxonomyAmbulatory Surgical Clinic/Center
License Number1999ASF788
License Number StateUT

VIII. Authorized Official

Name: RICHARD L SHARFF JR.
Title or Position: VP/SECRETARY
Credential:
Phone: 205-545-2572