FORM SURGERY CENTER LLC; NPI #1457863912

Contact Information

FORM SURGERY CENTER LLC

6322 S 3000 E STE 170
SALT LAKE CITY, UT 84121-7290

Phone: 801-513-3223
Fax:
Website:

	Specialty	Taxonomy Code	Specialty Code	Provider Type
	Ambulatory Surgical	261QA1903X	49	Ambulatory Surgical Center

Indicates primary specialty

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NPI Profile & details for FORM SURGERY CENTER LLC

NPI # 1457863912

LBN Legal business name FORM SURGERY CENTER LLC

Authorized official JANIE WARD - (OWNER)

Entity Organization

Organization subpart ¹ No

Enumeration date 10/24/2017

Last updated 04/05/2021 - About 5 years ago

Identifiers

License #

4972C

¹ Some organization health care providers are made up of components that furnish different types of health care or have separate physical locations where health care is furnished. These components and physical locations are not themselves legal entities, but are part of the organization health care provider (which is a legal entity). A covered organization provider may decide that its subparts (if it has any) should have their own NPI numbers. If a subpart conducts any HIPAA standard transactions on its own (e.g., separately from its parent), it must obtain its own NPI number.

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FORM SURGERY CENTER LLC

Contact Information

Specialty

Ambulatory Surgical

NPI Profile & details for FORM SURGERY CENTER LLC

Reviews for FORM SURGERY CENTER LLC