Healthcare Provider Details

I. General information

NPI: 1639704208
Provider Name (Legal Business Name): SALT LAKE SURGERY CENTER, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/04/2020
Last Update Date: 03/09/2020
Certification Date: 03/09/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1046 E 100 S STE D
SALT LAKE CITY UT
84102-1520
US

IV. Provider business mailing address

32902 WELTON CT
FULSHEAR TX
77441-4114
US

V. Phone/Fax

Practice location:
  • Phone: 435-300-0472
  • Fax:
Mailing address:
  • Phone: 281-881-3460
  • Fax:

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: MR. JOE REMES
Title or Position: ADMINISTRATOR
Credential:
Phone: 435-300-0472