Provider Demographics
NPI:1114097508
Name:BELNAP SURGICAL ASSOCIATES PC
Entity Type:Organization
Organization Name:BELNAP SURGICAL ASSOCIATES PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:LEGRAND
Authorized Official - Middle Name:P
Authorized Official - Last Name:BELNAP
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:801-262-9782
Mailing Address - Street 1:PO BOX 17600
Mailing Address - Street 2:
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84117-0600
Mailing Address - Country:US
Mailing Address - Phone:801-262-9782
Mailing Address - Fax:801-262-8632
Practice Address - Street 1:470 E 3900 S
Practice Address - Street 2:STE.200
Practice Address - City:SALT LAKE CITY
Practice Address - State:UT
Practice Address - Zip Code:84107-1880
Practice Address - Country:US
Practice Address - Phone:801-262-9782
Practice Address - Fax:801-262-8632
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-09
Last Update Date:2013-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT5250174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT000057224Medicare PIN