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General NPI Number Information
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NPI Number | 1487616793
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Entity Type | Organization
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Legal Business Name | SALT LAKE SURGICAL CENTER LP
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Dates
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Enumeration Date | 04/03/2006
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Last Update Date | 05/28/2009
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Provider Practice Location Address
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Address Line | 617 E 3900 S
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City | SALT LAKE CITY
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State | UT
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Zip | 84107-1901
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Country | US
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Telephone | 801-261-3141
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Fax |
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Provider Business Mailing Address
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Address Line | 617 E 3900 S
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City | SALT LAKE CITY
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State | UT
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Zip | 84107-1901
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Country | US
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Telephone | 801-261-3141
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Fax |
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Authorized Official
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Title or Position | VP/SECRETARY
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Name | RICHARD L SHARFF JR.
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Credential |
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Telephone | 205-545-2572
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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 | 1999ASF788
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License Number State | UT
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