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NPI Code Detail

MEDICARE: UTAH SPORTS AND ORTHOPEDICS

MEDICARE: UTAH SPORTS AND ORTHOPEDICS
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
1207RS0010XSports Medicine (Internal Medicine) Physician
22080S0010XPediatric Sports Medicine Physician
32081S0010XSports Medicine (Physical Medicine & Rehabilitation) Physician
42083S0010XSports Medicine (Preventive Medicine) Physician
52251S0007XSports Physical Therapist
6133VN1501XSports Dietetics Nutrition Registered Dietitian
7204C00000XSports Medicine (Neuromusculoskeletal Medicine) Physician
8207PS0010XSports Medicine (Emergency Medicine) Physician
9207QS0010XSports Medicine (Family Medicine) Physician
10207XX0005XSports Medicine (Orthopaedic Surgery) Physician

General Provider Information

NPI Number : 1790402170
Entity Type Code : Organization
Provider Name (Legal Business Name) : UTAH SPORTS AND ORTHOPEDICS
Provider Business Mailing Address
First Line : 2516 E SNOW MOUNTAIN DR
Second Line :
City : SANDY
State : UT
Zip : 84093-1858
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 2516 E SNOW MOUNTAIN DR
Second Line :
City : SANDY
State : UT
Zip : 84093-1858
Country : US
Telephone Number : 801-410-0205
Fax Number :
Authorized Official
Title or Position : CEO
Name : DR. KEVIN MANGUM
Credential : DO
Telephone Number : 801-410-0205
Provider Enumeration Date : 10/26/2022
Last Update Date : 10/26/2022

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Directions to “UTAH SPORTS AND ORTHOPEDICS ” Practice Location

Language Start Address Practice Location
These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

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