Basic Information
| Provider Information | |||||||||
| NPI: | 1033757166 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | MOUNTAIN WEST SPINE AND ORTHOPEDICS, LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 279 E 5900 S STE 100 | ||||||||
| Address2: | |||||||||
| City: | MURRAY | ||||||||
| State: | UT | ||||||||
| PostalCode: | 841075422 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8013142225 | ||||||||
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| Practice Location | |||||||||
| Address1: | 279 E 5900 S STE 100 | ||||||||
| Address2: | |||||||||
| City: | MURRAY | ||||||||
| State: | UT | ||||||||
| PostalCode: | 841075422 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8013142225 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 12/19/2019 | ||||||||
| LastUpdateDate: | 01/21/2020 | ||||||||
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| AuthorizedOfficialLastName: | HUNTSMAN | ||||||||
| AuthorizedOfficialFirstName: | KADE | ||||||||
| AuthorizedOfficialMiddleName: | T. | ||||||||
| AuthorizedOfficialTitleorPosition: | MEMBER | ||||||||
| AuthorizedOfficialTelephone: | 8014147420 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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| AuthorizedOfficialCredential: | MD | ||||||||
| NPICertificationDate: | 01/21/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207X00000X | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Orthopaedic Surgery |
No ID Information.