Healthcare Provider Details

I. General information

NPI: 1881701290
Provider Name (Legal Business Name): WASATCH ENDOSCOPY CENTER LTD
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/23/2006
Last Update Date: 04/06/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1220 E 3900 S STE 1B
SALT LAKE CITY UT
84124-1327
US

IV. Provider business mailing address

1220 E 3900 S STE 1B
SALT LAKE CITY UT
84124-1327
US

V. Phone/Fax

Practice location:
  • Phone: 801-281-3657
  • Fax: 801-281-4258
Mailing address:
  • Phone: 801-281-3657
  • Fax: 801-281-4258

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA1903X
TaxonomyAmbulatory Surgical Clinic/Center
License Number2006-ASF-769
License Number StateUT

VIII. Authorized Official

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