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General NPI Number Information
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NPI Number | 1659336881
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Entity Type | Organization
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Legal Business Name | MT. OGDEN SURGICAL CENTER LLC
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Dates
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Enumeration Date | 04/19/2006
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Last Update Date | 06/24/2010
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Provider Practice Location Address
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Address Line | 4364 WASHINGTON BLVD
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City | OGDEN
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State | UT
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Zip | 84403-1866
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Country | US
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Telephone | 801-479-4470
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Fax |
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Provider Business Mailing Address
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Address Line | 4364 WASHINGTON BLVD
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City | OGDEN
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State | UT
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Zip | 84403-1866
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Country | US
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Telephone | 801-479-4470
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Fax |
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Authorized Official
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Title or Position | ADMINISTRATOR
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Name | JEFFREY LOVE
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Credential |
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Telephone | 801-479-4470
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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 | 2005ASF880
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License Number State | UT
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