Provider Demographics
NPI:1487616793
Name:SALT LAKE SURGICAL CENTER LP
Entity type:Organization
Organization Name:SALT LAKE SURGICAL CENTER LP
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:VP/SECRETARY
Authorized Official - Prefix:
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:L
Authorized Official - Last Name:SHARFF
Authorized Official - Suffix:JR
Authorized Official - Credentials:
Authorized Official - Phone:205-545-2572
Mailing Address - Street 1:617 E 3900 S
Mailing Address - Street 2:
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84107-1901
Mailing Address - Country:US
Mailing Address - Phone:801-261-3141
Mailing Address - Fax:
Practice Address - Street 1:617 E 3900 S
Practice Address - Street 2:
Practice Address - City:SALT LAKE CITY
Practice Address - State:UT
Practice Address - Zip Code:84107-1901
Practice Address - Country:US
Practice Address - Phone:801-261-3141
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-04-03
Last Update Date:2009-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT1999ASF788261QA1903X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT000001002Medicare PIN
490005377Medicare PIN