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General NPI Number Information
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NPI Number | 1568644771
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Entity Type | Organization
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Legal Business Name | PHYSICIANS SERVICE GROUP, INC.
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Dates
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Enumeration Date | 11/29/2007
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Last Update Date | 11/29/2007
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Provider Practice Location Address
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Address Line | 7369 EAST 2223 SOUTH
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City | SALT LAKE CITY
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State | UT
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Zip | 84109
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Country | US
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Telephone | 801-664-1281
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 9126
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City | SALT LAKE CITY
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State | UT
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Zip | 84109-0126
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Country | US
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Telephone | 801-664-1281
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | GUY KIM DEHART
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Credential |
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Telephone | 801-664-1281
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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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