Provider Demographics
NPI:1033201124
Name:BRIGHAM CITY ORTHOPEDIC LLC
Entity Type:Organization
Organization Name:BRIGHAM CITY ORTHOPEDIC LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:H
Authorized Official - Last Name:SUMKO
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:435-734-2151
Mailing Address - Street 1:990 SOUTH MEDICAL DRIVE
Mailing Address - Street 2:SUITE G5
Mailing Address - City:BRIGHAM CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84302
Mailing Address - Country:US
Mailing Address - Phone:435-734-2151
Mailing Address - Fax:435-734-2151
Practice Address - Street 1:990 SOUTH MEDICAL DRIVE
Practice Address - Street 2:SUITE G5
Practice Address - City:BRIGHAM CITY
Practice Address - State:UT
Practice Address - Zip Code:84302
Practice Address - Country:US
Practice Address - Phone:435-734-2151
Practice Address - Fax:435-734-2151
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-28
Last Update Date:2008-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT000055232Medicare PIN
UT4152090001Medicare NSC