Organization Name: | SURGICAL SYNERGY, LLC |
NPI Number: | 1124489968 |
Entity Type Code: | Organizational (2) |
Authorized Official Name: | STEPHANIE BOULTER (MANAGER) |
Mailing Address: | 1624 E Cypress Point Way Draper |
State: | UT US |
Postal Code: | 840208808 |
Phone Number: | 8019951235 |
Fax Number: | |
NPI Enumeration Date: | 03/07/2016 |
NPI Last Update Date: | 03/07/2016 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 363AS0400X |
License Number: | 5192637-1206 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | UT |
Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
Taxonomy Classification: | Physician Assistant |
Taxonomy Specialization: | Surgical |
Taxonomy Definition: |