MEDICARE: RAPID ORTHOPEDIC CARE CLINIC LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207P00000X	Emergency Medicine Physician	5266933-1205	UT
2	207X00000X	Orthopaedic Surgery Physician	5280409-1205	UT

General Provider Information

NPI Number	:	1073767596
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	RAPID ORTHOPEDIC CARE CLINIC LLC

Provider Business Mailing Address
First Line	:	821 EAST 400 SOUTH
Second Line	:
City	:	SALT LAKE CITY
State	:	UT
Zip	:	84102-0000
Country	:	US
Telephone Number	:	801-708-7999
Fax Number	:	801-708-7998

Provider Business Practice Location Address
First Line	:	821 EAST 400 SOUTH
Second Line	:
City	:	SALT LAKE CITY
State	:	UT
Zip	:	84102-0000
Country	:	US
Telephone Number	:	801-708-7999
Fax Number	:	801-708-7998

Authorized Official
Title or Position	:	OWNER/CEO
Name	:	DR. BRIAN W FUKUSHIMA
Credential	:	MD
Telephone Number	:	801-708-7999

Provider Enumeration Date	:	11/11/2008
Last Update Date	:	11/11/2008

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