Provider Demographics
NPI:1912181421
Name:COLON & RECTAL CENTER OF UTAH P C
Entity Type:Organization
Organization Name:COLON & RECTAL CENTER OF UTAH P C
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:PETER
Authorized Official - Middle Name:W
Authorized Official - Last Name:BOSSART
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:801-263-1621
Mailing Address - Street 1:324 TENTH AVE
Mailing Address - Street 2:#280
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84103-2853
Mailing Address - Country:US
Mailing Address - Phone:801-408-5930
Mailing Address - Fax:801-408-5259
Practice Address - Street 1:1250 E 3900 S STE 320
Practice Address - Street 2:
Practice Address - City:SALT LAKE CITY
Practice Address - State:UT
Practice Address - Zip Code:84124-1350
Practice Address - Country:US
Practice Address - Phone:801-263-1621
Practice Address - Fax:801-906-0556
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-12-19
Last Update Date:2022-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT000055715Medicare PIN