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General NPI Number Information
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NPI Number | 1689998585
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Entity Type | Organization
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Legal Business Name | CENTRAL UTAH BARIATRICS
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Dates
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Enumeration Date | 03/21/2010
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Last Update Date | 03/21/2010
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Provider Practice Location Address
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Address Line | 43 W 700 S
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City | EPHRAIM
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State | UT
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Zip | 84627-1524
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Country | US
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Telephone | 435-340-0942
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Fax | 435-283-4412
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Provider Business Mailing Address
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Address Line | 43 W 700 S
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City | EPHRAIM
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State | UT
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Zip | 84627-1524
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Country | US
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Telephone | 435-340-0942
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Fax | 435-283-4412
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Authorized Official
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Title or Position | OWNER
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Name | DR. THOMAS RANDY HANSEN
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Credential | M.D.
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Telephone | 435-340-0942
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261Q00000X
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Taxonomy Name | Clinic/Center
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License Number |
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License Number State |
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