Healthcare Provider Details

I. General information

NPI: 1740461656
Provider Name (Legal Business Name): WASATCH SLEEP HEALTH CENTER, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/19/2007
Last Update Date: 10/27/2020
Certification Date: 10/27/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1345 EAST 3900 SOUTH STE 208
SALT LAKE CITY UT
84124-4416
US

IV. Provider business mailing address

1345 EAST 3900 SOUTH STE 208
SALT LAKE CITY UT
84124-4416
US

V. Phone/Fax

Practice location:
  • Phone: 801-281-1788
  • Fax: 801-281-2788
Mailing address:
  • Phone: 801-281-1788
  • Fax: 801-281-2788

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code174400000X
TaxonomySpecialist
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License Number
License Number State

VIII. Authorized Official

Name: DAVID SCOTT PETERSON
Title or Position: OWNER
Credential: M.D.
Phone: 801-281-1788