FORM SURGERY CENTER (NPI# 1457863912) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1457863912 |
| Entity Type | Organization |
| Organization Name | FORM SURGERY CENTER |
| Practice Address |
6322 S 3000 E Ste 170 Salt Lake City UT 84121-7290 |
| Practice Telephone | 8015133223 |
| Mailing Telephone | 8015133223 |
| Enumeration Date | 2017-10-24 |
| Last Update Date | 2017-10-24 |
| Authorized Official Name | JANIE WARD (OWNER) |
| Authorized Official Telephone | 8015133223 |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 261QA1903X |
Clinic/Center Specialization: Ambulatory Surgical |
4972C | UT | Ambulatory Health Care Facilities |
| Street Address |
6322 S 3000 E STE 170 |
| City | SALT LAKE CITY |
| State | UT |
| Zip Code | 84121-7290 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1649396185 | Preston Daniel Ward | Otolaryngology | 6322 S 3000 E Ste 170, Salt Lake City, UT 84121-7290 | 2007-03-22 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1407483522 | Kaitlyn Horne | Behavior Technician | 6910 S. Highland Drive, Cottonwood Heights, UT 84121 | 2020-03-26 |
| 1952936387 | Jared Wells | Behavior Technician | 6910 S Highland Drive, Cottonwood Heights, UT 84121 | 2020-03-05 |
| 1518591874 | Slc Plastic Surgery LLC | Plastic Surgery | 6686 Highland Drive, Cottonwood Heights, UT 84121 | 2020-02-26 |
| 1093273708 | Anna O'hearon | Counselor | New Roads Behavioral Health, 2450 Fort Union Blvd, Cottonwood Heights, UT 84121 | 2019-03-12 |
| 1053883181 | Charles Keller IIi | Pediatrics | 2198 S Yvonne Rd #344, Salt Lake City, UT 84121 | 2018-12-31 |
| 1669964516 | Marissa King | Specialist | 1141 E. 3900 S. Suite 150a, Salt Lake, UT 84121 | 2018-06-05 |
| 1376044313 | Slpd Cottonwood LLC | Dentist | 7167 South Highland Drive, 200, Cottonwood Heights, UT 84121 | 2018-02-26 |
| 1700315462 | Nelson & Tillmann Family Dentistry, PC | Dentist | 5872 S. 900 E. Ste 202, Salt Lake City, UT 84121 | 2017-06-07 |
| 1912430588 | Wasatch Midwifery and Wellness, LLC | Dietitian, Registered | 6440 S Wasatch Blvd, Ste 140, Holladay, UT 84121 | 2017-04-10 |
| 1407308331 | Tina Polgar | Registered Nurse | 6244 Highland Drive, Murray, UT 84121 | 2016-10-26 |
| Find all providers in zip 84121 | ||||
| Taxonomy Code | 261QA1903X |
| Grouping | Ambulatory Health Care Facilities |
| Classification | Clinic/Center |
| Specialization | Ambulatory Surgical |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1639704208 | Salt Lake Surgery Center, LLC | Clinic/Center | 1046 E 100 S Ste D, Salt Lake City, UT 84102-1520 | 2020-03-04 |
| 1952720674 | Bountiful Surgery Center, LLC | Clinic/Center | 6360 S 3000 E Ste 320, Salt Lake City, UT 84121-6932 | 2014-04-09 |
| 1932407277 | Stephen H Bennett Md PC | Clinic/Center | 1045 E 3900 S Ste 201, Salt Lake City, UT 84124-1192 | 2011-03-10 |
| 1568644771 | Physicians Service Group, Inc. | Clinic/Center | 7369 East 2223 South, Salt Lake City, UT 84109 | 2007-11-29 |
| 1780885442 | Lyssa Inc | Clinic/Center | 530 E 500 S, Salt Lake City, UT 84102-2746 | 2007-05-30 |
| 1790906204 | Ear, Nose & Throat Surgery Center of Utah LLC | Clinic/Center | 22 S 900 E Ste 2, Salt Lake City, UT 84102-1307 | 2007-05-01 |
| 1164647707 | Ihc Health Services, Inc. | Clinic/Center | 359 8th Ave, Salt Lake City, UT 84103-2895 | 2007-04-17 |
| 1922148063 | The Surgery Center At Salt Lake Regional, L.L.C. | Clinic/Center | 82 South 1100 East, Suite 200, Salt Lake City, UT 84102 | 2007-02-07 |
| 1881701290 | Wasatch Endoscopy Center Ltd | Clinic/Center | 1220 E 3900 S Ste 1b, Salt Lake City, UT 84124-1327 | 2006-08-23 |
| 1609896216 | Salt Lake Endoscopy Center | Clinic/Center | 24 S 1100 E Ste 103, Salt Lake City, UT 84102-1592 | 2006-07-20 |
| Find all providers in SALT LAKE CITY | ||||
| City | SALT LAKE CITY |
| Zip Code | 84121 |
Please comment or provide details below to improve the information on FORM SURGERY CENTER.
| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.