Provider Demographics
NPI:1346845138
Name:SURGERY CENTER AT COTTONWOOD, LLC
Entity Type:Organization
Organization Name:SURGERY CENTER AT COTTONWOOD, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VICE PRESIDENT OPERATIONS UTAH
Authorized Official - Prefix:MR
Authorized Official - First Name:ADAM
Authorized Official - Middle Name:
Authorized Official - Last Name:CHANDIO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:435-565-0704
Mailing Address - Street 1:5450 S GREEN ST STE B
Mailing Address - Street 2:
Mailing Address - City:MURRAY
Mailing Address - State:UT
Mailing Address - Zip Code:84123-5632
Mailing Address - Country:US
Mailing Address - Phone:801-262-5063
Mailing Address - Fax:
Practice Address - Street 1:5450 S GREEN ST STE B
Practice Address - Street 2:
Practice Address - City:MURRAY
Practice Address - State:UT
Practice Address - Zip Code:84123-5632
Practice Address - Country:US
Practice Address - Phone:801-262-5063
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-12-01
Last Update Date:2023-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical