=====================================================
General NPI Number Information
=====================================================
NPI Number | 1417833419
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | SALT LAKE ORTHOPAEDIC SPECIALIST, LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/14/2025
-----------------------------------------------------
Last Update Date | 08/14/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1184 E 80 N
-----------------------------------------------------
City | AMERICAN FORK
-----------------------------------------------------
State | UT
-----------------------------------------------------
Zip | 84003-2906
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 801-763-3885
-----------------------------------------------------
Fax | 801-763-3887
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 30015 DEPT 379
-----------------------------------------------------
City | SALT LAKE CITY
-----------------------------------------------------
State | UT
-----------------------------------------------------
Zip | 84130-0015
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 801-505-0821
-----------------------------------------------------
Fax | 801-505-0803
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | MD/OWNER
-----------------------------------------------------
Name | BRENT A FELIX
-----------------------------------------------------
Credential | MD
-----------------------------------------------------
Telephone | 801-284-8626
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 213ES0103X
-----------------------------------------------------
Taxonomy Name | Foot & Ankle Surgery Podiatrist
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------