Specialty |
Taxonomy Code | Specialty Code | Provider Type | |
Ambulatory Surgical |
261QA1903X | 49 | Ambulatory Surgical Center |
| NPI Number | 1437205028 |
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| LBN Legal business name | CENTRAL UTAH CLINIC, P.C. | ||||
| Authorized official | JED HARSTON - (DIRECTOR OF MANAGED CARE) | ||||
| Entity | Organization | ||||
| Organization subpart 1 | No | ||||
| Enumeration date | 01/26/2007 | ||||
| Last updated | 03/07/2018 - About 8 years ago | ||||
| Identifiers |
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