Provider Demographics
NPI:1073767596
Name:RAPID ORTHOPEDIC CARE CLINIC LLC
Entity Type:Organization
Organization Name:RAPID ORTHOPEDIC CARE CLINIC LLC
Other - Org Name:RAPID ORTHOPEDIC CARE CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:BRIAN
Authorized Official - Middle Name:W
Authorized Official - Last Name:FUKUSHIMA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:801-708-7999
Mailing Address - Street 1:821 EAST 400 SOUTH
Mailing Address - Street 2:
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84102-0000
Mailing Address - Country:US
Mailing Address - Phone:801-708-7999
Mailing Address - Fax:801-708-7998
Practice Address - Street 1:821 EAST 400 SOUTH
Practice Address - Street 2:
Practice Address - City:SALT LAKE CITY
Practice Address - State:UT
Practice Address - Zip Code:84102-0000
Practice Address - Country:US
Practice Address - Phone:801-708-7999
Practice Address - Fax:801-708-7998
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-11-11
Last Update Date:2008-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT5266933-1205207P00000X
UT5280409-1205207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Multi-Specialty
No207P00000XAllopathic & Osteopathic PhysiciansEmergency MedicineGroup - Multi-Specialty