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NPI Code Detail

MEDICARE: JBR SURGICAL CENTER, LLC

MEDICARE: JBR SURGICAL CENTER, 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
1207L00000XAnesthesiology Physician
2261QP3300XPain Clinic/Center
3261QP1100XPodiatric Clinic/Center
4261QA1903XAmbulatory Surgical Clinic/Center

General Provider Information

NPI Number : 1326660374
Entity Type Code : Organization
Provider Name (Legal Business Name) : JBR SURGICAL CENTER, 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 :
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 :
Authorized Official
Title or Position : OR MANAGER
Name : SANDRA WOODS
Credential :
Telephone Number : 801-261-2000
Provider Enumeration Date : 05/13/2020
Last Update Date : 06/24/2020

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Directions to “JBR SURGICAL CENTER, LLC ” Practice Location

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