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NPI Code Detail

MEDICARE: PARK TERRACE ANESTHESIA ASSOCIATES LLC

MEDICARE: PARK TERRACE ANESTHESIA ASSOCIATES 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
1261QA1903XAmbulatory Surgical Clinic/Center

General Provider Information

NPI Number : 1245843325
Entity Type Code : Organization
Provider Name (Legal Business Name) : PARK TERRACE ANESTHESIA ASSOCIATES LLC
Provider Business Mailing Address
First Line : 650 E 4500 S STE 100
Second Line :
City : SALT LAKE CITY
State : UT
Zip : 84107-4536
Country : US
Telephone Number : 801-261-2000
Fax Number : 801-261-4539
Provider Business Practice Location Address
First Line : 650 E 4500 S STE 100
Second Line :
City : SALT LAKE CITY
State : UT
Zip : 84107-4536
Country : US
Telephone Number : 801-261-2000
Fax Number : 801-261-4539
Authorized Official
Title or Position : CEO
Name : THOMAS WARDLE
Credential :
Telephone Number : 801-261-2000
Provider Enumeration Date : 08/28/2020
Last Update Date : 08/28/2020

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Directions to “PARK TERRACE ANESTHESIA ASSOCIATES LLC ” Practice Location

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