Provider Demographics
NPI:1093996167
Name:MOUNTAINSTAR CARDIOVASCULAR SERVICES LLC
Entity Type:Organization
Organization Name:MOUNTAINSTAR CARDIOVASCULAR SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:KIRT
Authorized Official - Middle Name:L
Authorized Official - Last Name:PETERSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:801-743-4750
Mailing Address - Street 1:698 W 800 N
Mailing Address - Street 2:SUITE #210
Mailing Address - City:OREM
Mailing Address - State:UT
Mailing Address - Zip Code:84057-3658
Mailing Address - Country:US
Mailing Address - Phone:801-714-6412
Mailing Address - Fax:801-714-6413
Practice Address - Street 1:698 W 800 N
Practice Address - Street 2:SUITE #210
Practice Address - City:OREM
Practice Address - State:UT
Practice Address - Zip Code:84057-3658
Practice Address - Country:US
Practice Address - Phone:801-714-6412
Practice Address - Fax:801-714-6413
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-16
Last Update Date:2007-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208G00000XAllopathic & Osteopathic PhysiciansThoracic Surgery (Cardiothoracic Vascular Surgery)Group - Single Specialty