Provider Demographics
NPI:1073048344
Name:SOUTH VALLEY ORTHOMED, PLLC
Entity Type:Organization
Organization Name:SOUTH VALLEY ORTHOMED, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:D
Authorized Official - Last Name:SONNENBERG
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:801-566-4242
Mailing Address - Street 1:10623 S REDWOOD RD
Mailing Address - Street 2:STE 101
Mailing Address - City:SOUTH JORDAN
Mailing Address - State:UT
Mailing Address - Zip Code:84095-2481
Mailing Address - Country:US
Mailing Address - Phone:801-566-4242
Mailing Address - Fax:801-987-3493
Practice Address - Street 1:10623 S REDWOOD RD
Practice Address - Street 2:STE 101
Practice Address - City:SOUTH JORDAN
Practice Address - State:UT
Practice Address - Zip Code:84095-2481
Practice Address - Country:US
Practice Address - Phone:801-566-4242
Practice Address - Fax:801-987-3493
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-04-25
Last Update Date:2017-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Single Specialty