Provider Demographics
NPI:1306236690
Name:UTAH NEUROSURGERY PC
Entity type:Organization
Organization Name:UTAH NEUROSURGERY PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:COO
Authorized Official - Prefix:
Authorized Official - First Name:BROCK
Authorized Official - Middle Name:
Authorized Official - Last Name:RASMUSSEN
Authorized Official - Suffix:
Authorized Official - Credentials:MBA
Authorized Official - Phone:435-688-7131
Mailing Address - Street 1:1490 E FOREMASTER DR
Mailing Address - Street 2:STE 260
Mailing Address - City:SAINT GEORGE
Mailing Address - State:UT
Mailing Address - Zip Code:84790-4488
Mailing Address - Country:US
Mailing Address - Phone:435-688-7131
Mailing Address - Fax:435-304-1055
Practice Address - Street 1:1490 E FOREMASTER DR
Practice Address - Street 2:STE 260
Practice Address - City:SAINT GEORGE
Practice Address - State:UT
Practice Address - Zip Code:84790-4488
Practice Address - Country:US
Practice Address - Phone:435-688-7131
Practice Address - Fax:435-304-1055
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-01-26
Last Update Date:2015-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT294901-1205207T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207T00000XAllopathic & Osteopathic PhysiciansNeurological SurgeryGroup - Single Specialty