Provider Demographics
NPI:1497941603
Name:PREMIER PLASTIC SURGERY GROUP OF UTAH, L.L.C.
Entity Type:Organization
Organization Name:PREMIER PLASTIC SURGERY GROUP OF UTAH, L.L.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PARTNER
Authorized Official - Prefix:
Authorized Official - First Name:STEVEN
Authorized Official - Middle Name:H
Authorized Official - Last Name:WARNOCK
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:801-571-2020
Mailing Address - Street 1:9829 S 1300 E
Mailing Address - Street 2:200
Mailing Address - City:SANDY
Mailing Address - State:UT
Mailing Address - Zip Code:84094-4000
Mailing Address - Country:US
Mailing Address - Phone:801-571-2020
Mailing Address - Fax:801-571-6899
Practice Address - Street 1:9829 S 1300 E
Practice Address - Street 2:200
Practice Address - City:SANDY
Practice Address - State:UT
Practice Address - Zip Code:84094-4000
Practice Address - Country:US
Practice Address - Phone:801-571-2020
Practice Address - Fax:801-571-6899
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-20
Last Update Date:2008-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty