Provider Demographics
NPI:1164530903
Name:RICHARDS GENERAL SURGERY PC
Entity Type:Organization
Organization Name:RICHARDS GENERAL SURGERY PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ONWER/OPERATOR
Authorized Official - Prefix:DR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:TAYLOR
Authorized Official - Last Name:RICHARDS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:801-262-2830
Mailing Address - Street 1:5249 GRAVENSTEIN PARK
Mailing Address - Street 2:
Mailing Address - City:MURRAY
Mailing Address - State:UT
Mailing Address - Zip Code:84123-4562
Mailing Address - Country:US
Mailing Address - Phone:801-262-2830
Mailing Address - Fax:888-893-1576
Practice Address - Street 1:175 N 100 W
Practice Address - Street 2:STE 202
Practice Address - City:VERNAL
Practice Address - State:UT
Practice Address - Zip Code:84078-2049
Practice Address - Country:US
Practice Address - Phone:435-789-4180
Practice Address - Fax:435-781-1185
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-29
Last Update Date:2011-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT5586768-1205208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT396421983001Medicaid
UT55878120001OtherBLUE CROSS BLUE SHIELD
UT005770801/000057708Medicare ID - Type Unspecified
UT396421983001Medicaid