# NORTHERN UTAH SURGERY CENTER, LLC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1770188740
- **Authorized official:** MR. BRIAN SHELTON (BOARD MEMBER)
- **Authorized official phone:** (435) 787-7190

## Contact information

- **Practice address:** 55 E GOLF COURSE RD, LOGAN, UT 84321-0001
- **Practice address phone:** (435) 787-7190
- **Mailing address:** 55 E GOLF COURSE RD, LOGAN, UT 84321-0001
- **Mailing address phone:** (435) 787-7190

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 261QA1903X | Ambulatory Surgical Clinic/Center | — | NULL | Yes |

## Other

- **Enumeration date:** 11/30/2020
- **Last updated:** 11/30/2020