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Organization
FORM SURGERY CENTER LLC
Active
Organization
FORM SURGERY CENTER LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JANIE WARD (OWNER)
(801) 513-3223
Entity
Organization
Contact information
Practice address
6322 S 3000 E STE 170, SALT LAKE CITY, UT 84121-7290
(801) 513-3223
Mailing address
6322 S 3000 E STE 170, SALT LAKE CITY, UT 84121-7290
(801) 513-3223
Taxonomy
Speciality
Code
Description
License number
State
261QA1903X
Ambulatory Surgical Clinic/Center
Primary
4972C
UT
Other
Enumeration date
10/24/2017
Last updated
04/05/2021
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