Provider Demographics
NPI:1558142471
Name:UTAH PODIATRIC PHYSICIANS AND SURGEONS GROUP LLC
Entity Type:Organization
Organization Name:UTAH PODIATRIC PHYSICIANS AND SURGEONS GROUP LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:LAURA
Authorized Official - Middle Name:
Authorized Official - Last Name:DAY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:515-867-0937
Mailing Address - Street 1:PO BOX 30015 DEPT 356
Mailing Address - Street 2:
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84130
Mailing Address - Country:US
Mailing Address - Phone:515-867-0937
Mailing Address - Fax:385-300-0846
Practice Address - Street 1:3435 E PONY EXPRESS PKWY STE 140
Practice Address - Street 2:
Practice Address - City:EAGLE MOUNTAIN
Practice Address - State:UT
Practice Address - Zip Code:84005-5548
Practice Address - Country:US
Practice Address - Phone:801-789-2444
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:UTAH PODIATRIC PHYSICIANS AND SURGEONS GROUP LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2023-10-06
Last Update Date:2023-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center