Organization Name: | MOUNTAIN WEST SURGERY CENTER, LLC |
NPI Number: | 1003119470 |
Entity Type Code: | Organizational (2) |
Authorized Official Name: | DON LIEDTKE (CFO) |
Mailing Address: | 1551 South Renaissance Towne Dr Suite 200 Bountiful |
State: | UT US |
Postal Code: | 840107668 |
Phone Number: | 8013831111 |
Fax Number: | 8013831115 |
NPI Enumeration Date: | 12/07/2010 |
NPI Last Update Date: | 12/15/2010 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 261QA1903X |
License Number: | |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | |
Taxonomy Type: | Ambulatory Health Care Facilities |
Taxonomy Classification: | Clinic/Center |
Taxonomy Specialization: | Ambulatory Surgical |
Taxonomy Definition: |