Provider Demographics
NPI:1043745987
Name:UTAH PODIATRIC PHYSICIANS AND SURGEONS GROUP LLC
Entity Type:Organization
Organization Name:UTAH PODIATRIC PHYSICIANS AND SURGEONS GROUP LLC
Other - Org Name:UTAH MUSCULOSKELETAL SPECIALISTS (UMS)
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CHAIRMAN
Authorized Official - Prefix:
Authorized Official - First Name:DANIEL
Authorized Official - Middle Name:L
Authorized Official - Last Name:PREECE
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:801-532-1822
Mailing Address - Street 1:144 S 700 E
Mailing Address - Street 2:
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84102-1357
Mailing Address - Country:US
Mailing Address - Phone:801-532-1822
Mailing Address - Fax:801-532-7544
Practice Address - Street 1:150 N MAIN ST STE 202
Practice Address - Street 2:
Practice Address - City:HEBER CITY
Practice Address - State:UT
Practice Address - Zip Code:84032-1671
Practice Address - Country:US
Practice Address - Phone:435-671-4726
Practice Address - Fax:435-654-4026
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-04-28
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT5587758-0501213E00000X, 213EP1101X, 213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Multi-Specialty
No213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Multi-Specialty
No213EP1101XPodiatric Medicine & Surgery Service ProvidersPodiatristPrimary Podiatric MedicineGroup - Multi-Specialty