1811954886 NPI number — PHYSICIANS SURGICAL CENTER

Table of content: (NPI 1811954886)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1811954886 NPI number — PHYSICIANS SURGICAL CENTER

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
PHYSICIANS SURGICAL CENTER
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:
6
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:
1811954886
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 2265
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SANDY
Provider Business Mailing Address State Name:
UT
Provider Business Mailing Address Postal Code:
84091-2265
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
801-495-1064
Provider Business Mailing Address Fax Number:
801-523-1139

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
151 E 5600 S
Provider Second Line Business Practice Location Address:
SUITE 104
Provider Business Practice Location Address City Name:
MURRAY
Provider Business Practice Location Address State Name:
UT
Provider Business Practice Location Address Postal Code:
84107-6181
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
801-288-1211
Provider Business Practice Location Address Fax Number:
801-685-2242
Provider Enumeration Date:
04/26/2006

Additional Information

Authorized Official

Authorized Official Last Name:
DEHART
Authorized Official First Name:
BRIAN
Authorized Official Middle Name:
J
Authorized Official Title or Position:
OWNER/PRESIDENT
Authorized Official Telephone Number:
801-816-1187

Provider Taxonomy Codes

  • Taxonomy code: 261QA1903X , 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)

  • Identifier: 864951 , issued by the state of ( AZ ) . This identifiers is of the category "MEDICAID".




Copyright © 2007-2025 www.npivalidator.com