Basic Information
| Provider Information | |||||||||
| NPI: | 1619347135 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | UTAH SPINE INSTITUTE | ||||||||
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| Mailing Information | |||||||||
| Address1: | 5801 S FASHION BLVD | ||||||||
| Address2: | SUITE 180 | ||||||||
| City: | MURRAY | ||||||||
| State: | UT | ||||||||
| PostalCode: | 841076159 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8012627246 | ||||||||
| FaxNumber: | 8012623442 | ||||||||
| Practice Location | |||||||||
| Address1: | 5801 S FASHION BLVD | ||||||||
| Address2: | SUITE 180 | ||||||||
| City: | MURRAY | ||||||||
| State: | UT | ||||||||
| PostalCode: | 841076159 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8012627246 | ||||||||
| FaxNumber: | 8012623442 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/26/2015 | ||||||||
| LastUpdateDate: | 09/26/2015 | ||||||||
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| AuthorizedOfficialLastName: | GARG | ||||||||
| AuthorizedOfficialFirstName: | VIKAS | ||||||||
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| AuthorizedOfficialTitleorPosition: | MEDICAL DIRECTOR/ OWNER | ||||||||
| AuthorizedOfficialTelephone: | 2062250724 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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| AuthorizedOfficialCredential: | M.D, MSA | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261QA1903X | 261QA1903X | UT | Y | Ambulatory Health Care Facilities | Clinic/Center | Ambulatory Surgical |
No ID Information.