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General NPI Number Information
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NPI Number | 1356395586
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Entity Type | Organization
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Legal Business Name | PHYSICIANS SURGERY CENTER, LLC
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Dates
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Enumeration Date | 05/20/2006
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Last Update Date | 07/08/2014
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Provider Practice Location Address
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Address Line | 1485 E 3900 S
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City | SALT LAKE CITY
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State | UT
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Zip | 84124-1412
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Country | US
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Telephone | 801-277-2062
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Fax | 801-274-3233
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Provider Business Mailing Address
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Address Line | 1485 E 3900 S
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City | SALT LAKE CITY
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State | UT
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Zip | 84124-1412
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Country | US
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Telephone | 801-277-2062
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Fax | 801-274-3233
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Authorized Official
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Title or Position | M.D. MANAGER - MEMBER
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Name | KEVIN H. CHARLTON
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Credential | M.D.
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Telephone | 801-277-2062
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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 | 2006-ASF-74408
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License Number State | UT
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