MEDICARE: ST MARKS AMBULATORY SURGERY ASSOCIATES LP

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	261QA1903X	Ambulatory Surgical Clinic/Center	2005ASF519	UT

General Provider Information

NPI Number	:	1174587984
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ST MARKS AMBULATORY SURGERY ASSOCIATES LP

Provider Business Mailing Address
First Line	:	1250 E 3900 S
Second Line	:	SUITE 100
City	:	SALT LAKE CITY
State	:	UT
Zip	:	84124-1348
Country	:	US
Telephone Number	:	801-262-0358
Fax Number	:	801-262-0901

Provider Business Practice Location Address
First Line	:	1250 E 3900 S
Second Line	:	SUITE 100
City	:	SALT LAKE CITY
State	:	UT
Zip	:	84124-1348
Country	:	US
Telephone Number	:	801-262-0358
Fax Number	:	801-262-0901

Authorized Official
Title or Position	:	VP
Name	:	WILLIAM GREGORY SWINNEY
Credential	:
Telephone Number	:	972-789-2877

Provider Enumeration Date	:	04/17/2006
Last Update Date	:	04/17/2024

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