Provider Demographics
NPI:1619347135
Name:UTAH SPINE INSTITUTE
Entity Type:Organization
Organization Name:UTAH SPINE INSTITUTE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR/ OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:VIKAS
Authorized Official - Middle Name:
Authorized Official - Last Name:GARG
Authorized Official - Suffix:
Authorized Official - Credentials:MD, MSA
Authorized Official - Phone:206-225-0724
Mailing Address - Street 1:5801 S FASHION BLVD
Mailing Address - Street 2:SUITE 180
Mailing Address - City:MURRAY
Mailing Address - State:UT
Mailing Address - Zip Code:84107-6159
Mailing Address - Country:US
Mailing Address - Phone:801-262-7246
Mailing Address - Fax:801-262-3442
Practice Address - Street 1:5801 S FASHION BLVD
Practice Address - Street 2:SUITE 180
Practice Address - City:MURRAY
Practice Address - State:UT
Practice Address - Zip Code:84107-6159
Practice Address - Country:US
Practice Address - Phone:801-262-7246
Practice Address - Fax:801-262-3442
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-09-26
Last Update Date:2015-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT261QA1903X261QA1903X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical