Provider Demographics
NPI:1689833436
Name:SURGICAL CARE ASSOCIATES
Entity Type:Organization
Organization Name:SURGICAL CARE ASSOCIATES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:MEGAN
Authorized Official - Middle Name:R
Authorized Official - Last Name:WHITTAKER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:435-628-4507
Mailing Address - Street 1:P.O. BOX 910735
Mailing Address - Street 2:
Mailing Address - City:SAINT GEORGE
Mailing Address - State:UT
Mailing Address - Zip Code:84791-0735
Mailing Address - Country:US
Mailing Address - Phone:435-628-4507
Mailing Address - Fax:435-628-3748
Practice Address - Street 1:1025 EAST 3300 SOUTH
Practice Address - Street 2:SUITE B
Practice Address - City:SALT LAKE CITY
Practice Address - State:UT
Practice Address - Zip Code:84106-4389
Practice Address - Country:US
Practice Address - Phone:435-628-4507
Practice Address - Fax:435-628-3748
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-06-06
Last Update Date:2012-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT1122810010207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT639146817091Medicaid
UT000057342Medicare PIN