Healthcare Provider Details

I. General information

NPI: 1922396720
Provider Name (Legal Business Name): WEST SHORES SURGICAL CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/13/2011
Last Update Date: 07/13/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2792 S 5600 W SUITE A
WEST VALLEY CITY UT
84120-5590
US

IV. Provider business mailing address

2792 S 5600 W SUITE A
WEST VALLEY CITY UT
84120-5590
US

V. Phone/Fax

Practice location:
  • Phone: 801-969-9669
  • Fax: 801-969-9779
Mailing address:
  • Phone: 801-969-9669
  • Fax: 801-969-9779

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: DR. GREGORY BIDDULPH
Title or Position: OWNER
Credential: D.M.D.
Phone: 801-969-9669