Provider Demographics
NPI:1336264050
Name:UTAH VASCULAR CENTER
Entity Type:Organization
Organization Name:UTAH VASCULAR CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:COO
Authorized Official - Prefix:
Authorized Official - First Name:LEON
Authorized Official - Middle Name:JAMES
Authorized Official - Last Name:JENSEN
Authorized Official - Suffix:JR
Authorized Official - Credentials:
Authorized Official - Phone:801-225-6246
Mailing Address - Street 1:1055 N 300 W STE 205
Mailing Address - Street 2:
Mailing Address - City:PROVO
Mailing Address - State:UT
Mailing Address - Zip Code:84604-5044
Mailing Address - Country:US
Mailing Address - Phone:801-374-9100
Mailing Address - Fax:801-374-9117
Practice Address - Street 1:1055 N 300 W STE 205
Practice Address - Street 2:
Practice Address - City:PROVO
Practice Address - State:UT
Practice Address - Zip Code:84604-5044
Practice Address - Country:US
Practice Address - Phone:801-374-9100
Practice Address - Fax:801-374-9117
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-20
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Multi-Specialty