Basic Information
| Provider Information | |||||||||
| NPI: | 1477200947 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | SALT CREEK ANESTHESIA PLLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 139 | ||||||||
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| City: | NEPHI | ||||||||
| State: | UT | ||||||||
| PostalCode: | 846480139 | ||||||||
| CountryCode: | US | ||||||||
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| Practice Location | |||||||||
| Address1: | 48 W 1500 N | ||||||||
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| City: | NEPHI | ||||||||
| State: | UT | ||||||||
| PostalCode: | 846488900 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4356233000 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 03/04/2022 | ||||||||
| LastUpdateDate: | 03/04/2022 | ||||||||
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| AuthorizedOfficialLastName: | HADLOCK | ||||||||
| AuthorizedOfficialFirstName: | SAMUEL | ||||||||
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| AuthorizedOfficialTitleorPosition: | CO-OWNER | ||||||||
| AuthorizedOfficialTelephone: | 8013804164 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | CRNA | ||||||||
| NPICertificationDate: | 03/04/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207L00000X | Y | 193400000X MULTIPLE SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Anesthesiology |
No ID Information.