Organization
GENESIS VASCULAR OF SALT LAKE
Active
Parent organization
GENESIS VASCULAR OF SALT LAKE
Other names
Genesis Vascular of Salt Lake, LLC
Organization subpart
Yes
Provider details
NPI number
Legal business name
GENESIS VASCULAR OF SALT LAKE
Authorized official
DENNIS MUNFORD (MANAGER)
(385) 388-8003
Entity
Organization
Contact information
Practice address
6321 S REDWOOD RD, SUITE 102, SALT LAKE CITY, UT 84123-6798
(385) 388-8003
(385) 344-4006
Mailing address
6321 S REDWOOD RD STE 102, TAYLORSVILLE, UT 84123-6799
(385) 388-8003
(385) 344-4006
Taxonomy
Speciality
Code
Description
License number
State
207RI0011X
Interventional Cardiology Physician
Primary
—
—
2085R0204X
Vascular & Interventional Radiology Physician
—
—
2086S0129X
Vascular Surgery Physician
—
—
Other
Enumeration date
12/21/2016
Last updated
10/07/2020
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