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General NPI Number Information
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NPI Number | 1811973589
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Entity Type | Organization
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Legal Business Name | DAVIS SURGICAL CENTER, LLC
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Dates
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Enumeration Date | 12/15/2005
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Last Update Date | 03/28/2012
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Provider Practice Location Address
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Address Line | 1544 W ANTELOPE DR
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City | LAYTON
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State | UT
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Zip | 84041-1146
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Country | US
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Telephone | 801-773-3339
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Fax |
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Provider Business Mailing Address
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Address Line | 1544 W ANTELOPE DR
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City | LAYTON
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State | UT
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Zip | 84041-1146
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Country | US
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Telephone | 801-773-3339
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Fax |
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Authorized Official
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Title or Position | ADMINISTRATOR
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Name | MRS. DANECE FICKETT FICKETT
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Credential | RN
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Telephone | 801-773-3339
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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 | 2004-ASF-909
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License Number State | UT
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