Provider Demographics
NPI:1063790574
Name:JEFFREY BELL
Entity type:Organization
Organization Name:JEFFREY BELL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:JEFFREY
Authorized Official - Middle Name:LOGAN
Authorized Official - Last Name:BELL
Authorized Official - Suffix:
Authorized Official - Credentials:CRNA
Authorized Official - Phone:801-690-6019
Mailing Address - Street 1:1180 N WINSTON DR
Mailing Address - Street 2:
Mailing Address - City:KAYSVILLE
Mailing Address - State:UT
Mailing Address - Zip Code:84037-1353
Mailing Address - Country:US
Mailing Address - Phone:801-690-6019
Mailing Address - Fax:
Practice Address - Street 1:1485 E 3900 S
Practice Address - Street 2:
Practice Address - City:SALT LAKE CITY
Practice Address - State:UT
Practice Address - Zip Code:84124-1438
Practice Address - Country:US
Practice Address - Phone:801-277-2062
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-08-01
Last Update Date:2011-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT295819-4406367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified RegisteredGroup - Single Specialty