MEDICARE: CENTRAL UTAH BARIATRICS

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	261Q00000X	Clinic/Center

General Provider Information

NPI Number	:	1689998585
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CENTRAL UTAH BARIATRICS

Provider Business Mailing Address
First Line	:	43 W 700 S
Second Line	:
City	:	EPHRAIM
State	:	UT
Zip	:	84627-1524
Country	:	US
Telephone Number	:	435-340-0942
Fax Number	:	435-283-4412

Provider Business Practice Location Address
First Line	:	43 W 700 S
Second Line	:
City	:	EPHRAIM
State	:	UT
Zip	:	84627-1524
Country	:	US
Telephone Number	:	435-340-0942
Fax Number	:	435-283-4412

Authorized Official
Title or Position	:	OWNER
Name	:	DR. THOMAS RANDY HANSEN
Credential	:	M.D.
Telephone Number	:	435-340-0942

Provider Enumeration Date	:	03/21/2010
Last Update Date	:	03/21/2010

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