Provider Demographics
NPI:1053440891
Name:ASHDOWN SURGICAL PC
Entity Type:Organization
Organization Name:ASHDOWN SURGICAL PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JAN
Authorized Official - Middle Name:
Authorized Official - Last Name:ASHDOWN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:435-723-1114
Mailing Address - Street 1:950 MEDICAL DR
Mailing Address - Street 2:SUITE 104
Mailing Address - City:BRIGHAM CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84302-4724
Mailing Address - Country:US
Mailing Address - Phone:435-723-1114
Mailing Address - Fax:435-723-1173
Practice Address - Street 1:950 MEDICAL DR
Practice Address - Street 2:SUITE 104
Practice Address - City:BRIGHAM CITY
Practice Address - State:UT
Practice Address - Zip Code:84302-4724
Practice Address - Country:US
Practice Address - Phone:435-723-1114
Practice Address - Fax:435-723-1173
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-05
Last Update Date:2008-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT186908-1205208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT529907188006Medicaid
UT000062621Medicare PIN
ID1378337Medicare PIN
UT529907188006Medicaid