Provider Demographics
NPI:1629023858
Name:OGDEN ORTHOPAEDIC SPECIALISTS LLC
Entity type:Organization
Organization Name:OGDEN ORTHOPAEDIC SPECIALISTS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:VICKIE
Authorized Official - Middle Name:H
Authorized Official - Last Name:ANDERSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:801-387-2618
Mailing Address - Street 1:4403 HARRISON BLVD
Mailing Address - Street 2:SUITE 2600
Mailing Address - City:OGDEN
Mailing Address - State:UT
Mailing Address - Zip Code:84403
Mailing Address - Country:US
Mailing Address - Phone:801-387-2600
Mailing Address - Fax:801-387-2625
Practice Address - Street 1:4403 HARRISON BLVD
Practice Address - Street 2:SUITE 2600
Practice Address - City:OGDEN
Practice Address - State:UT
Practice Address - Zip Code:84403
Practice Address - Country:US
Practice Address - Phone:801-387-2600
Practice Address - Fax:801-387-2625
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-24
Last Update Date:2008-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT4360680001Medicare NSC