MEDICARE: CHURCH OF JESUS CHRIST OF LATTER-DAY SAINTS

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	208G00000X	Thoracic Surgery (Cardiothoracic Vascular Surgery) Physician	169094-8905	UT

General Provider Information

NPI Number	:	1598093676
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CHURCH OF JESUS CHRIST OF LATTER-DAY SAINTS

Provider Business Mailing Address
First Line	:	50 E NORTH TEMPLE
Second Line	:
City	:	SALT LAKE CITY
State	:	UT
Zip	:	84150-9001
Country	:	US
Telephone Number	:	801-240-7733
Fax Number	:

Provider Business Practice Location Address
First Line	:	50 E NORTH TEMPLE
Second Line	:
City	:	SALT LAKE CITY
State	:	UT
Zip	:	84150-9001
Country	:	US
Telephone Number	:	801-240-7733
Fax Number	:

Authorized Official
Title or Position	:	DIRECTOR, MISSIONARY SERVICES
Name	:	MR. ROBERT SWENSEN
Credential	:
Telephone Number	:	801-240-6807

Provider Enumeration Date	:	11/30/2009
Last Update Date	:	11/30/2009

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