Provider Demographics
NPI:1790927044
Name:MD RASMUSSEN, PC
Entity Type:Organization
Organization Name:MD RASMUSSEN, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT /CHAIR PERSON
Authorized Official - Prefix:MR
Authorized Official - First Name:MERWIN
Authorized Official - Middle Name:D
Authorized Official - Last Name:RASMUSSEN
Authorized Official - Suffix:
Authorized Official - Credentials:CRNA
Authorized Official - Phone:801-432-8748
Mailing Address - Street 1:1954 FT UNION BLVD
Mailing Address - Street 2:STE 108
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84121-6800
Mailing Address - Country:US
Mailing Address - Phone:801-993-9564
Mailing Address - Fax:801-733-5618
Practice Address - Street 1:3460 PIONEER PKWY
Practice Address - Street 2:
Practice Address - City:WEST VALLEY CITY
Practice Address - State:UT
Practice Address - Zip Code:84120-2049
Practice Address - Country:US
Practice Address - Phone:801-964-3100
Practice Address - Fax:801-733-5618
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-04-01
Last Update Date:2009-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT211689-4406367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified RegisteredGroup - Single Specialty