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General NPI Number Information
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NPI Number | 1538572169
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Entity Type | Organization
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Legal Business Name | VINCENT SURGICAL ARTS, LLC
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Dates
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Enumeration Date | 06/11/2014
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Last Update Date | 06/11/2014
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Provider Practice Location Address
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Address Line | 6710 S BLACKSTONE RD SUITE 201
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City | COTTONWOOD HEIGHTS
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State | UT
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Zip | 84121-6072
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Country | US
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Telephone | 801-942-1111
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Fax | 801-942-1188
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Provider Business Mailing Address
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Address Line | 6710 S BLACKSTONE RD SUITE 201
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City | COTTONWOOD HEIGHTS
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State | UT
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Zip | 84121-6072
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Country | US
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Telephone | 801-942-1111
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Fax | 801-942-1188
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Authorized Official
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Title or Position | MEDICAL DIRECTOR
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Name | DR. DRAKE G VINCENT
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Credential | M.D.
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Telephone | 801-942-1111
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2086S0122X
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Taxonomy Name | Plastic and Reconstructive Surgery Physician
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License Number | 5767298-8905
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License Number State | UT
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