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General NPI Number Information
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NPI Number | 1346611035
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Entity Type | Organization
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Legal Business Name | SURGICAL SPECIALTIES LLC
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Dates
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Enumeration Date | 10/07/2015
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Last Update Date | 10/07/2015
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Provider Practice Location Address
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Address Line | 2940 N CHURCH ST
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City | LAYTON
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State | UT
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Zip | 84040-6614
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Country | US
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Telephone | 801-430-0405
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Fax |
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Provider Business Mailing Address
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Address Line | 1086 E HIGHWAY 193
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City | LAYTON
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State | UT
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Zip | 84040-8572
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | MEMBER
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Name | MATT GERTGE
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Credential |
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Telephone | 801-430-0405
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QA1903X
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Taxonomy Name | Ambulatory Surgical Clinic/Center
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License Number |
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License Number State |
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