Provider Demographics
NPI:1003119470
Name:MOUNTAIN WEST SURGERY CENTER, LLC
Entity Type:Organization
Organization Name:MOUNTAIN WEST SURGERY CENTER, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VP
Authorized Official - Prefix:
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:GREGORY
Authorized Official - Last Name:SWINNEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:972-789-2877
Mailing Address - Street 1:1551 SOUTH RENAISSANCE TOWNE DR
Mailing Address - Street 2:SUITE 200
Mailing Address - City:BOUNTIFUL
Mailing Address - State:UT
Mailing Address - Zip Code:84010-7668
Mailing Address - Country:US
Mailing Address - Phone:801-383-1111
Mailing Address - Fax:801-383-1115
Practice Address - Street 1:1551 SOUTH RENAISSANCE TOWNE DR
Practice Address - Street 2:SUITE 200
Practice Address - City:BOUNTIFUL
Practice Address - State:UT
Practice Address - Zip Code:84010-7668
Practice Address - Country:US
Practice Address - Phone:801-383-1111
Practice Address - Fax:801-383-1115
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-12-07
Last Update Date:2018-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical