=====================================================
General NPI Number Information
=====================================================
NPI Number | 1164647707
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | AVENUES SURGERY CENTER, LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/17/2007
-----------------------------------------------------
Last Update Date | 12/15/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 359 E 8TH AVE
-----------------------------------------------------
City | SALT LAKE CITY
-----------------------------------------------------
State | UT
-----------------------------------------------------
Zip | 84103-2895
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 385-355-7278
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 359 E 8TH AVE
-----------------------------------------------------
City | SALT LAKE CITY
-----------------------------------------------------
State | UT
-----------------------------------------------------
Zip | 84103-2895
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 385-355-7275
-----------------------------------------------------
Fax | 801-326-4621
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | BOARD CHAIRMAN
-----------------------------------------------------
Name | HEATHER WALL
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 801-408-2504
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261QA1903X
-----------------------------------------------------
Taxonomy Name | Ambulatory Surgical Clinic/Center
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------