Provider Demographics
NPI:1952485237
Name:CENTER FOR COLON AND RECTAL DISEASES LLC
Entity Type:Organization
Organization Name:CENTER FOR COLON AND RECTAL DISEASES LLC
Other - Org Name:CCRD
Other - Org Type:Other Name
Authorized Official - Title/Position:PRACTICE ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:TERESA
Authorized Official - Middle Name:M
Authorized Official - Last Name:LEVER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:801-265-3978
Mailing Address - Street 1:348 E 4500 S
Mailing Address - Street 2:SUITE 200
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84107-3906
Mailing Address - Country:US
Mailing Address - Phone:801-265-3978
Mailing Address - Fax:801-265-3988
Practice Address - Street 1:348 E 4500 S
Practice Address - Street 2:SUITE 200
Practice Address - City:SALT LAKE CITY
Practice Address - State:UT
Practice Address - Zip Code:84107-3906
Practice Address - Country:US
Practice Address - Phone:801-265-3978
Practice Address - Fax:801-265-3988
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-24
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Single Specialty