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NPI Code Detail

MEDICARE: CITY CREEK SURGICAL SERVICES

MEDICARE: CITY CREEK SURGICAL SERVICES
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 : 1295187730
Entity Type Code : Organization
Provider Name (Legal Business Name) : CITY CREEK SURGICAL SERVICES
Provider Business Mailing Address
First Line : 1046 E 100 S
Second Line : SUITE D
City : SALT LAKE CITY
State : UT
Zip : 84102-1520
Country : US
Telephone Number : 801-746-2885
Fax Number :
Provider Business Practice Location Address
First Line : 1046 E 100 S
Second Line : SUITE D
City : SALT LAKE CITY
State : UT
Zip : 84102-1520
Country : US
Telephone Number : 801-746-2885
Fax Number :
Authorized Official
Title or Position : OWNER
Name : DANIEL COTTAM
Credential : MD
Telephone Number : 801-746-2885
Provider Enumeration Date : 07/08/2016
Last Update Date : 07/08/2016

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Directions to “CITY CREEK SURGICAL SERVICES ” Practice Location

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