UTAH SPINE CARE, LLC (NPI# 1700173473) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1700173473 |
| Entity Type | Organization |
| Organization Name | UTAH SPINE CARE, LLC |
| Other Organization Name | UTAH SPINE CARE |
| Practice Address |
4403 Harrison Blvd Ste 1815 Ogden UT 84403-3271 |
| Practice Telephone | 8017325950 |
| Practice Fax Number | 8017325988 |
| Mailing Telephone | 8017325950 |
| Mailing Fax Number | 8017325988 |
| Enumeration Date | 2011-07-01 |
| Last Update Date | 2016-10-03 |
| Authorized Official Name | TROY FULLER (PRACTICE ADMINISTRATOR) |
| Authorized Official Telephone | 8017325950 |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 207LP2900X |
Anesthesiology Specialization: Pain Medicine |
1835611205 | UT | Allopathic & Osteopathic Physicians |
| N | 208100000X | Physical Medicine & Rehabilitation | 1765801205 | UT | Allopathic & Osteopathic Physicians |
| Y | 207T00000X | Neurological Surgery | 2626351205 | UT | Allopathic & Osteopathic Physicians |
| Other Name | Type Code |
|---|---|
| Utah Spine Care | Doing Business As Name - Organization |
| Street Address |
4403 HARRISON BLVD STE 1815 |
| City | OGDEN |
| State | UT |
| Zip Code | 84403-3271 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1518962794 | Fred George Seale Iv | Obstetrics & Gynecology | 4403 Harrison Blvd, Ste 4650, Ogden, UT 84403-3271 | 2005-06-15 |
| 1720502859 | Derek Smith | Physician Assistant | 4403 Harrison Blvd, Ogden, UT 84403-3271 | 2017-07-31 |
| 1245766393 | Jacob Saunders | Student in an Organized Health Care Education/Training Program | 4403 Harrison Blvd, Suite A-700, Ogden, UT 84403-3271 | 2017-05-11 |
| 1043746191 | Haleigh Emerson | Family Medicine | 4403 Harrison Blvd, Suite A700, Ogden, UT 84403-3271 | 2017-05-11 |
| 1457887507 | Madison Beatty | Student in an Organized Health Care Education/Training Program | 4403 Harrison Blvd, Suite A700, Ogden, UT 84403 | 2017-05-11 |
| 1669908711 | Spencer Ruben | Student in an Organized Health Care Education/Training Program | 4403 Harrison Blvd, Suite A700, Ogden, UT 84403-3271 | 2017-05-11 |
| 1376083147 | Linda Maria Jones | Nurse Practitioner | 4403 Harrison Blvd, Suite 3490, Ogden, UT 84403 | 2017-02-27 |
| 1114376431 | Jonas Legrand Peterson | Family Medicine | 4403 Harrison Blvd, Suite A-700, Ogden, UT 84403-3271 | 2016-06-07 |
| 1649629965 | Derek Paul Wille | Family Medicine | 4403 Harrison Blvd, Suite A-700, Ogden, UT 84403-3271 | 2016-06-07 |
| 1467838086 | Brandy Millward | Social Worker | 4403 Harrison Blvd, Suite 3630, Ogden, UT 84403-3271 | 2015-08-05 |
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| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1235744632 | Megan Louise Larkins | Specialist/Technologist | 4000 Brinker Ave. The Apartments., Apartment 15, Ogden, UT 84403 | 2020-09-11 |
| 1154959062 | Joshua Clifford Hansen | Student in an Organized Health Care Education/Training Program | 4403 Harrison Boulevard, Ste A700, Ogden, UT 84403 | 2020-03-28 |
| 1346895935 | Positional Release Therapy Institute LLC | Specialist/Technologist | 1702 E. 5600 S., Ogden, UT 84403 | 2019-08-09 |
| 1841842077 | Braken Wooden | Chiropractor | 1893 Skyline Dr., Suite 204, South Ogden, UT 84403 | 2019-07-09 |
| 1023670569 | Wasatch Advanced Dental Care LLC | Dentist | 3590 Harrison Blvd Suite #1, Ogden, UT 84403 | 2019-07-05 |
| 1194237636 | Marci Niemeyer | Physician Assistant | 5929 Fashion Point Dr Ste 101, South Ogden, UT 84403 | 2017-10-24 |
| 1578081949 | Stephanie Jensen | Specialist/Technologist | 1473 36th Street, Ogden, UT 84403 | 2017-09-06 |
| 1891213385 | Forrest Sutherland | Specialist/Technologist | 1075 E 41st St., Ogden, UT 84403 | 2017-09-05 |
| 1184159022 | Nicole Lee Van Tassell | In Home Supportive Care | 1496 East 5600 South, Unit 6, Ogden, UT 84403 | 2017-04-28 |
| 1265889166 | Modern Dental Professionals Ut, PC | Dentist | 5974 S. Fashion Pointe Drive, Suite 210, South Ogden, UT 84403 | 2016-05-20 |
| Find all providers in zip 84403 | ||||
| Taxonomy Code | 207T00000X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Neurological Surgery |
| A neurological surgeon provides the operative and non-operative management (i.e., prevention, diagnosis, evaluation, treatment, critical care, and rehabilitation) of disorders of the central, peripheral, and autonomic nervous systems, including their supporting structures and vascular supply; the evaluation and treatment of pathological processes which modify function or activity of the nervous system; and the operative and non-operative management of pain. A neurological surgeon treats patients with disorders of the nervous system; disorders of the brain, meninges, skull, and their blood supply, including the extracranial carotid and vertebral arteries; disorders of the pituitary gland; disorders of the spinal cord, meninges, and vertebral column, including those which may require treatment by spinal fusion or instrumentation; and disorders of the cranial and spinal nerves throughout their distribution. |
| Notes: Source: American Board of Medical Specialties, 2007. www.abms.org [7/1/2007: definiton added, source added] Additional Resources: American Board of Neurological Surgery, 2007. http://www.abns.org/. Board certification for Medical Doctors (MDs) is provided by the American Board of Neurological Surgery. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1265723423 | Jeffrey Clay Aucoin | Neurological Surgery | 4403 Harrison Blvd Ste 1815, Ogden, UT 84403 | 2011-04-22 |
| 1710151980 | Blake G. Welling | Neurological Surgery | 4403 Harrison Blvd, #1815, Ogden, UT 84403-3339 | 2008-04-17 |
| 1710166020 | Dennis D. Winters Md PC | Neurological Surgery | 4403 Harrison Blvd, Suite 1815, Ogden, UT 84403-3271 | 2007-11-02 |
| 1003004672 | Bryson S. Smith, Md, PC | Neurological Surgery | 4403 Harrison Blvd, Suite 1815, Ogden, UT 84403-3271 | 2007-10-09 |
| 1750586624 | Christopher F. Penka, M.d., P.a., Inc. | Neurological Surgery | 4403 Harrison Blvd Ste 1815, Ogden, UT 84403-3271 | 2007-06-19 |
| 1770627234 | Blake Welling, Md PC | Neurological Surgery | 4403 Harrison Blvd, Suite 1815, Ogden, UT 84403-3271 | 2007-02-17 |
| 1215948799 | Kurt D Bangerter | Neurological Surgery | 4403 Harrison Blvd, Ste 1815, Ogden, UT 84403-3339 | 2006-08-10 |
| 1194769604 | Dennis Damian Winters | Neurological Surgery | 4403 Harrison Blvd, Suite 1815, Ogden, UT 84403-3271 | 2006-06-15 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1073975660 | Robert Kim | Neurological Surgery | 175 N Medical Drive East 5th Floor, Salt Lake City, UT 84132-0001 | 2016-03-23 |
| 1912341009 | Andrea Brock | Neurological Surgery | 3000 N Triumph Blvd Ste 330, Lehi, UT 84043-4999 | 2013-04-19 |
| 1689819146 | James Leo Mcgauley | Neurological Surgery | 8884 Alpen Way, Salt Lake City, UT 84121-6159 | 2008-12-11 |
| 1861645087 | Sarah Tamara Menacho | Neurological Surgery | 175 North Medical Drive East, 5th Floor, University of Utah Department of Neurosurgery, Salt Lake City, UT 84132-0001 | 2008-10-31 |
| 1902074115 | Dr Evan G Black LLC | Neurological Surgery | 5323 Woodrow St # 120w, Suite 201, Murray, UT 84107-5841 | 2008-02-11 |
| 1437331592 | Dr Diana D Banks, LLC | Neurological Surgery | 5323 South 120 West, Suite 201, Salt Lake City, UT 84107 | 2007-11-30 |
| 1316165947 | Utah Neurological Clinic, Inc. | Neurological Surgery | 1055 N. 300 W. Ste 400, Provo, UT 84604 | 2007-04-20 |
| 1730249582 | James C Pingree | Neurological Surgery | 1220 E 3900 S Ste 4e, Salt Lake City, UT 84124-1343 | 2006-12-11 |
| 1235219130 | Richard H. Schmidt | Neurological Surgery | 175 N Medical Dr Fl 5, Salt Lake City, UT 84132-2303 | 2006-10-16 |
| 1487744090 | Joel Douglas Macdonald | Neurological Surgery | 82 S 1100 E Ste 103, Salt Lake City, UT 84102-1889 | 2006-10-13 |
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| 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.