Provider Demographics
NPI:1568590743
Name:OGDEN ORTHOPAEDIC SPECIALISTS LLC
Entity Type:Organization
Organization Name:OGDEN ORTHOPAEDIC SPECIALISTS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JACK
Authorized Official - Middle Name:W
Authorized Official - Last Name:CROSLAND
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:801-479-9860
Mailing Address - Street 1:6112 S 1550 E
Mailing Address - Street 2:SUITE 202
Mailing Address - City:OGDEN
Mailing Address - State:UT
Mailing Address - Zip Code:84405-5608
Mailing Address - Country:US
Mailing Address - Phone:801-479-9860
Mailing Address - Fax:801-476-8821
Practice Address - Street 1:6112 S 1550 E
Practice Address - Street 2:SUITE 202
Practice Address - City:OGDEN
Practice Address - State:UT
Practice Address - Zip Code:84405-5608
Practice Address - Country:US
Practice Address - Phone:801-479-9860
Practice Address - Fax:801-476-8821
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-01
Last Update Date:2008-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
4360680002Medicare NSC