1447267554 NPI number — CEDAR SURGICAL ASSOCIATES LC

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1447267554 NPI number — CEDAR SURGICAL ASSOCIATES LC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CEDAR SURGICAL ASSOCIATES LC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1447267554
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/26/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1811 W ROYAL HUNTE DR STE 3
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CEDAR CITY
Provider Business Mailing Address State Name:
UT
Provider Business Mailing Address Postal Code:
84720-8352
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
435-586-3402
Provider Business Mailing Address Fax Number:
435-867-4945

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1811 W ROYAL HUNTE DR STE 3
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CEDAR CITY
Provider Business Practice Location Address State Name:
UT
Provider Business Practice Location Address Postal Code:
84720-8352
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
435-586-3402
Provider Business Practice Location Address Fax Number:
435-867-4945
Provider Enumeration Date:
08/02/2006

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
ANDERSON
Authorized Official First Name:
CHAD
Authorized Official Middle Name:
W
Authorized Official Title or Position:
MEDICAL DIRECTOR
Authorized Official Telephone Number:
435-586-3402

Provider Taxonomy Codes

  • Taxonomy code: 261QA1903X , with the licence number:  EXEMPT , registered in the state of UT ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)