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General NPI Number Information
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NPI Number | 1881870434
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Entity Type | Organization
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Legal Business Name | SELAROM SURGICAL CENTER, LLC
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Dates
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Enumeration Date | 01/14/2008
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Last Update Date | 10/02/2008
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Provider Practice Location Address
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Address Line | 5089 S 900 E #100
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City | SALT LAKE CITY
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State | UT
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Zip | 84117-5735
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Country | US
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Telephone | 801-743-0700
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Fax | 801-743-0701
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Provider Business Mailing Address
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Address Line | 5089 S 900 E #100
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City | SALT LAKE CITY
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State | UT
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Zip | 84117-5735
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Country | US
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Telephone | 801-743-0700
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Fax | 801-743-0701
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Authorized Official
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Title or Position | ADMINISTRATOR
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Name | LOUIS MORALES JR.
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Credential | M.D.
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Telephone | 801-743-0700
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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 | EXEMPT
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License Number State | UT
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