Provider Demographics
NPI:1073302782
Name:BRIGHAM CITY SURGERY CENTER LLC
Entity type:Organization
Organization Name:BRIGHAM CITY SURGERY CENTER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:GREGORY
Authorized Official - Middle Name:
Authorized Official - Last Name:COOK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:909-245-2381
Mailing Address - Street 1:325 MEADOW VIEW LN
Mailing Address - Street 2:
Mailing Address - City:NIBLEY
Mailing Address - State:UT
Mailing Address - Zip Code:84321-7944
Mailing Address - Country:US
Mailing Address - Phone:909-245-2381
Mailing Address - Fax:909-245-2365
Practice Address - Street 1:1041 S MEDICAL DR STE 100
Practice Address - Street 2:
Practice Address - City:BRIGHAM CITY
Practice Address - State:UT
Practice Address - Zip Code:84302-3099
Practice Address - Country:US
Practice Address - Phone:909-245-2381
Practice Address - Fax:909-245-2365
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-05-01
Last Update Date:2025-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical