Provider Demographics
NPI:1710019831
Name:ADVANCED ORTHOPEDICS & SPORTS MEDICINE
Entity type:Organization
Organization Name:ADVANCED ORTHOPEDICS & SPORTS MEDICINE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING PARTNER
Authorized Official - Prefix:
Authorized Official - First Name:LIONEL
Authorized Official - Middle Name:E
Authorized Official - Last Name:WEEKS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:801-355-2424
Mailing Address - Street 1:1060 E 100 S
Mailing Address - Street 2:SUITE 101
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84102-1501
Mailing Address - Country:US
Mailing Address - Phone:801-355-2424
Mailing Address - Fax:801-355-4848
Practice Address - Street 1:1060 E 100 S
Practice Address - Street 2:SUITE 101
Practice Address - City:SALT LAKE CITY
Practice Address - State:UT
Practice Address - Zip Code:84102-1501
Practice Address - Country:US
Practice Address - Phone:801-355-2424
Practice Address - Fax:801-355-4848
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-12
Last Update Date:2007-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Single Specialty