# TOOELE UROLOGY LLC

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- **Entity:** Organization
- **Status:** Active
- **Parent organization:** UROLOGIC SURGERY ASSOCIATES
- **Organization subpart:** Yes

## Provider details

- **NPI number:** 1457599912
- **Legal business name:** UROLOGIC SURGERY ASSOCIATES
- **Authorized official:** DR. DAN HIBBERT MD (MANAGER)
- **Authorized official phone:** (801) 822-2727

## Contact information

- **Practice address:** 11179 IVY CREEK CV, SOUTH JORDAN, UT 84095-2249
- **Practice address phone:** (801) 822-2727
- **Mailing address:** 11179 IVY CREEK CV, SOUTH JORDAN, UT 84095-2249
- **Mailing address phone:** (801) 822-2727

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 261QL0400X | Lithotripsy Clinic/Center | 7100427-1205 | UT | — |
| 261QM2500X | Medical Specialty Clinic/Center | 7100427-1205 | UT | Yes |

## Other

- **Enumeration date:** 01/21/2009
- **Last updated:** 09/25/2019