Provider Demographics
NPI:1467513358
Name:ORTHOPEDIC SERVICES OF UTAH
Entity Type:Organization
Organization Name:ORTHOPEDIC SERVICES OF UTAH
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:CHRIS
Authorized Official - Middle Name:D
Authorized Official - Last Name:DOWLING
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:801-949-4943
Mailing Address - Street 1:415 EAST 1550 NORTH
Mailing Address - Street 2:
Mailing Address - City:OREM
Mailing Address - State:UT
Mailing Address - Zip Code:84097
Mailing Address - Country:US
Mailing Address - Phone:801-949-4943
Mailing Address - Fax:801-227-0111
Practice Address - Street 1:555 SOUTH STATE STREET
Practice Address - Street 2:SUITE 205
Practice Address - City:OREM
Practice Address - State:UT
Practice Address - Zip Code:84058-6398
Practice Address - Country:US
Practice Address - Phone:801-802-8464
Practice Address - Fax:801-227-0111
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-13
Last Update Date:2016-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT199009315332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
84140088101001OtherBCBS
190227900OtherOWCE WORKERS COMP
C08445242OtherELECTRONIC
QM0000026815OtherALTIUS
UT=========008Medicaid
UT0420950001Medicare ID - Type Unspecified