Provider Demographics
NPI:1982445698
Name:UTAH PODIATRIC PHYSICIANS AND SURGEONS GROUP LLC
Entity type:Organization
Organization Name:UTAH PODIATRIC PHYSICIANS AND SURGEONS GROUP LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BILLING MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:BECKY
Authorized Official - Middle Name:
Authorized Official - Last Name:HOSKING
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:801-882-2001
Mailing Address - Street 1:PO BOX 30015 DEPT 356
Mailing Address - Street 2:
Mailing Address - City:SLC
Mailing Address - State:UT
Mailing Address - Zip Code:84130
Mailing Address - Country:US
Mailing Address - Phone:801-882-2001
Mailing Address - Fax:385-300-0846
Practice Address - Street 1:6321 S REDWOOD RD STE 102
Practice Address - Street 2:
Practice Address - City:TAYLORSVILLE
Practice Address - State:UT
Practice Address - Zip Code:84123-6799
Practice Address - Country:US
Practice Address - Phone:385-440-9333
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-06-05
Last Update Date:2024-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP1100XAmbulatory Health Care FacilitiesClinic/CenterPodiatric