Provider Demographics
NPI:1083897185
Name:U OF U PLASTIC SURGERY ASSOCIATES
Entity Type:Organization
Organization Name:U OF U PLASTIC SURGERY ASSOCIATES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BILLING MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:JEFF
Authorized Official - Middle Name:
Authorized Official - Last Name:WARE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:801-581-7073
Mailing Address - Street 1:PO BOX 58049
Mailing Address - Street 2:
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84158-0049
Mailing Address - Country:US
Mailing Address - Phone:801-581-7073
Mailing Address - Fax:801-581-5794
Practice Address - Street 1:30 N 1900 E
Practice Address - Street 2:RM 3B400
Practice Address - City:SALT LAKE CITY
Practice Address - State:UT
Practice Address - Zip Code:84132-0006
Practice Address - Country:US
Practice Address - Phone:801-581-7073
Practice Address - Fax:801-581-5794
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-12-11
Last Update Date:2007-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT5034170-4405363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGroup - Single Specialty