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General NPI Number Information
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NPI Number | 1629032305
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Entity Type | Organization
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Legal Business Name | UTAH SURGICAL CENTER, LLC
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Dates
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Enumeration Date | 04/12/2006
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Last Update Date | 04/20/2008
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Provider Practice Location Address
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Address Line | 3715 W 4100 S
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City | WEST VALLEY CITY
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State | UT
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Zip | 84120-5537
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Country | US
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Telephone | 801-957-0200
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Fax | 801-957-0201
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Provider Business Mailing Address
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Address Line | PO BOX 26211
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City | SALT LAKE CITY
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State | UT
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Zip | 84126-0211
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Country | US
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Telephone | 801-957-0200
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Fax | 801-957-0201
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Authorized Official
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Title or Position | ADMINISTRATOR
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Name | MRS. MARLA JENSEN
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Credential | RN, BSN
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Telephone | 801-957-0200
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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 | UT
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