Provider Demographics
NPI:1518713304
Name:ROSENBERG COOLEY METCALF LC
Entity Type:Organization
Organization Name:ROSENBERG COOLEY METCALF LC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:GARRETT
Authorized Official - Middle Name:
Authorized Official - Last Name:DAVIS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:435-655-6600
Mailing Address - Street 1:900 ROUND VALLEY DR STE 100
Mailing Address - Street 2:
Mailing Address - City:PARK CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84060-7552
Mailing Address - Country:US
Mailing Address - Phone:435-655-6600
Mailing Address - Fax:435-655-2388
Practice Address - Street 1:380 E 1500 S STE 103
Practice Address - Street 2:
Practice Address - City:HEBER CITY
Practice Address - State:UT
Practice Address - Zip Code:84032-3940
Practice Address - Country:US
Practice Address - Phone:435-657-3640
Practice Address - Fax:435-655-2388
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ROSENBERG COOLEY METCALF LC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2024-04-24
Last Update Date:2024-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Multi-Specialty
No207XX0005XAllopathic & Osteopathic PhysiciansOrthopaedic SurgerySports MedicineGroup - Multi-Specialty