Healthcare Provider Details

I. General information

NPI: 1497941603
Provider Name (Legal Business Name): PREMIER PLASTIC SURGERY GROUP OF UTAH, L.L.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/20/2007
Last Update Date: 01/15/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9829 S 1300 E 200
SANDY UT
84094-4000
US

IV. Provider business mailing address

9829 S 1300 E 200
SANDY UT
84094-4000
US

V. Phone/Fax

Practice location:
  • Phone: 801-571-2020
  • Fax: 801-571-6899
Mailing address:
  • Phone: 801-571-2020
  • Fax: 801-571-6899

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number
License Number State

VIII. Authorized Official

Name: STEVEN H WARNOCK
Title or Position: PARTNER
Credential: M.D.
Phone: 801-571-2020