Healthcare Provider Details

I. General information

NPI: 1164647707
Provider Name (Legal Business Name): AVENUES SURGERY CENTER, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/17/2007
Last Update Date: 12/15/2025
Certification Date: 12/15/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

359 E 8TH AVE
SALT LAKE CITY UT
84103-2895
US

IV. Provider business mailing address

359 E 8TH AVE
SALT LAKE CITY UT
84103-2895
US

V. Phone/Fax

Practice location:
  • Phone: 385-355-7278
  • Fax:
Mailing address:
  • Phone: 385-355-7275
  • Fax: 801-326-4621

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: HEATHER WALL
Title or Position: BOARD CHAIRMAN
Credential:
Phone: 801-408-2504