Basic Information
| Provider Information | |||||||||
| NPI: | 1306879820 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | MILLCREEK ANESTHESIA PC | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 3690 | ||||||||
| Address2: | |||||||||
| City: | SALT LAKE CITY | ||||||||
| State: | UT | ||||||||
| PostalCode: | 841103690 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8017272060 | ||||||||
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| Practice Location | |||||||||
| Address1: | 1200 E 3900 S | ||||||||
| Address2: | |||||||||
| City: | SALT LAKE CITY | ||||||||
| State: | UT | ||||||||
| PostalCode: | 841241300 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8017272060 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 07/08/2006 | ||||||||
| LastUpdateDate: | 09/10/2009 | ||||||||
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| AuthorizedOfficialLastName: | THURGOOD | ||||||||
| AuthorizedOfficialFirstName: | RANDY | ||||||||
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| AuthorizedOfficialTitleorPosition: | PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 8017272060 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | MD | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207L00000X | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Anesthesiology |
No ID Information.