Healthcare Provider Details

I. General information

NPI: 1245474139
Provider Name (Legal Business Name): ORTHOPAEDIC SPINE SURGEONS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/23/2009
Last Update Date: 04/23/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

590 WAKARA WAY
SALT LAKE CITY UT
84108-1200
US

IV. Provider business mailing address

PO BOX 58108
SALT LAKE CITY UT
84158-0108
US

V. Phone/Fax

Practice location:
  • Phone: 801-587-7109
  • Fax:
Mailing address:
  • Phone: 801-581-3998
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2086S0127X
TaxonomyTrauma Surgery Physician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207XS0117X
TaxonomyOrthopaedic Surgery of the Spine Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. CHARLES L SALTZMAN
Title or Position: DEPARTMENT CHAIR
Credential: MD
Phone: 801-587-7109