MEDICARE: SALT LAKE ORTHOPAEDIC SPECIALIST, 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
1	174400000X	Specialist	5211	UT

General Provider Information

NPI Number	:	1811913429
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SALT LAKE ORTHOPAEDIC SPECIALIST, LLC

Provider Business Mailing Address
First Line	:	280 S MAIN ST
Second Line	:
City	:	BOUNTIFUL
State	:	UT
Zip	:	84010-6236
Country	:	US
Telephone Number	:	801-505-0821
Fax Number	:	801-505-0803

Provider Business Practice Location Address
First Line	:	1521 E 3900 S STE 200
Second Line	:
City	:	SALT LAKE CITY
State	:	UT
Zip	:	84124-1501
Country	:	US
Telephone Number	:	801-262-8486
Fax Number	:	801-284-8699

Authorized Official
Title or Position	:	PRESIDENT
Name	:	BRENT A FELIX
Credential	:	M.D.
Telephone Number	:	801-262-8486

Provider Enumeration Date	:	07/15/2006
Last Update Date	:	08/28/2024

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