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General NPI Number Information
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NPI Number | 1114959616
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Entity Type | Organization
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Legal Business Name | ADVANCED ORTHOPEDICS AND SPORTS MEDICINE
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Dates
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Enumeration Date | 07/06/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 8785 JORDAN VALLEY WAY
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City | WEST JORDAN
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State | UT
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Zip | 84088-9772
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Country | US
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Telephone | 801-568-3480
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Fax | 801-568-3482
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Provider Business Mailing Address
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Address Line | 8785 JORDAN VALLEY WAY
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City | WEST JORDAN
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State | UT
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Zip | 84088-9772
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Country | US
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Telephone | 801-568-3480
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Fax | 801-568-3482
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Authorized Official
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Title or Position | CLINIC MANAGER
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Name | MR. CARL JOHNSON
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Credential |
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Telephone | 801-568-3480
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | 22772
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License Number State | UT
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