Provider Demographics
NPI:1851008650
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
Mailing Address - Street 2:DEPT 356
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84130
Mailing Address - Country:US
Mailing Address - Phone:801-882-2001
Mailing Address - Fax:801-447-1314
Practice Address - Street 1:1561 W 7000 S STE 201
Practice Address - Street 2:
Practice Address - City:WEST JORDAN
Practice Address - State:UT
Practice Address - Zip Code:84084-3556
Practice Address - Country:US
Practice Address - Phone:801-561-1011
Practice Address - Fax:801-447-1314
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-11-01
Last Update Date:2022-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Single Specialty