Provider Demographics
NPI:1851777353
Name:UTAH ORTHOPEDIC, SPINE & INJURY CENTER
Entity Type:Organization
Organization Name:UTAH ORTHOPEDIC, SPINE & INJURY CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:RUTH
Authorized Official - Middle Name:
Authorized Official - Last Name:DAVIDSON
Authorized Official - Suffix:
Authorized Official - Credentials:JD
Authorized Official - Phone:435-729-9200
Mailing Address - Street 1:15 NORMANS WAY
Mailing Address - Street 2:
Mailing Address - City:PARK CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84060-6895
Mailing Address - Country:US
Mailing Address - Phone:435-729-9200
Mailing Address - Fax:435-608-9900
Practice Address - Street 1:6360 S 3000 E
Practice Address - Street 2:
Practice Address - City:SALT LAKE CITY
Practice Address - State:UT
Practice Address - Zip Code:84121-6923
Practice Address - Country:US
Practice Address - Phone:801-797-8000
Practice Address - Fax:435-608-9900
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-08-06
Last Update Date:2015-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT70109741205207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Multi-Specialty