Provider Demographics
NPI:1952597932
Name:EASTERN UTAH SURGICAL CENTER
Entity Type:Organization
Organization Name:EASTERN UTAH SURGICAL CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:JEFFREY
Authorized Official - Middle Name:E
Authorized Official - Last Name:HANSEN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:435-637-1744
Mailing Address - Street 1:200 N FAIRGROUNDS RD STE 1
Mailing Address - Street 2:
Mailing Address - City:PRICE
Mailing Address - State:UT
Mailing Address - Zip Code:84501-4228
Mailing Address - Country:US
Mailing Address - Phone:435-637-1744
Mailing Address - Fax:435-637-1123
Practice Address - Street 1:200 N FAIRGROUNDS RD STE 1
Practice Address - Street 2:
Practice Address - City:PRICE
Practice Address - State:UT
Practice Address - Zip Code:84501-4228
Practice Address - Country:US
Practice Address - Phone:435-637-1744
Practice Address - Fax:435-637-1123
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-24
Last Update Date:2010-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty