Provider Demographics
NPI:1720260714
Name:WASATCH NEUROSURGERY & SPINE
Entity Type:Organization
Organization Name:WASATCH NEUROSURGERY & SPINE
Other - Org Name:RICHARD H SCHWARTZ MD PC
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:H
Authorized Official - Last Name:SCHWARTZ
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:801-261-8507
Mailing Address - Street 1:1220 E 3900 S
Mailing Address - Street 2:# 4-E
Mailing Address - City:SLC
Mailing Address - State:UT
Mailing Address - Zip Code:84124
Mailing Address - Country:US
Mailing Address - Phone:801-261-8507
Mailing Address - Fax:801-261-8511
Practice Address - Street 1:1220 E 3900 S
Practice Address - Street 2:# 4-E
Practice Address - City:SLC
Practice Address - State:UT
Practice Address - Zip Code:84124-1327
Practice Address - Country:US
Practice Address - Phone:801-261-8507
Practice Address - Fax:801-261-8511
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-30
Last Update Date:2007-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT1805671205207T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207T00000XAllopathic & Osteopathic PhysiciansNeurological SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT495504853020Medicaid