Provider Demographics
NPI:1477695187
Name:NEUROSURGICAL ASSOCIATES LLC
Entity Type:Organization
Organization Name:NEUROSURGICAL ASSOCIATES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTICE ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:SHALENE
Authorized Official - Middle Name:
Authorized Official - Last Name:GRIFFITH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:801-507-9542
Mailing Address - Street 1:5171 COTTONWOOD ST
Mailing Address - Street 2:# 950
Mailing Address - City:MURRAY
Mailing Address - State:UT
Mailing Address - Zip Code:84107-5704
Mailing Address - Country:US
Mailing Address - Phone:801-507-9555
Mailing Address - Fax:801-507-9550
Practice Address - Street 1:5171 COTTONWOOD ST
Practice Address - Street 2:# 950
Practice Address - City:MURRAY
Practice Address - State:UT
Practice Address - Zip Code:84107-5704
Practice Address - Country:US
Practice Address - Phone:801-507-9555
Practice Address - Fax:801-507-9550
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-12
Last Update Date:2013-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT19794774207T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207T00000XAllopathic & Osteopathic PhysiciansNeurological SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT5678280001Medicare NSC
UT000057293Medicare ID - Type Unspecified
UTDA3544Medicare ID - Type UnspecifiedRAILROAD MEDICARE
UT000057351Medicare ID - Type UnspecifiedMEDICARE PARK CITY