Healthcare Provider Details

I. General information

NPI: 1952720674
Provider Name (Legal Business Name): BOUNTIFUL SURGERY CENTER, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/09/2014
Last Update Date: 04/05/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6360 S 3000 E STE 320
SALT LAKE CITY UT
84121-6932
US

IV. Provider business mailing address

6360 S 3000 E SUITE 320
SALT LAKE CITY UT
84121-6923
US

V. Phone/Fax

Practice location:
  • Phone: 801-944-3166
  • Fax:
Mailing address:
  • Phone: 801-944-3166
  • 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: WILLIAM GREGORY SWINNEY
Title or Position: VP
Credential:
Phone: 972-789-2877