Organization
MOUNTAINWEST SURGICAL CENTER LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. BRIAN BERG (ADMINISTRATOR)
(801) 383-1111
Entity
Organization
Contact information
Practice address
1551 S RENAISSANCE TOWNE DR, SUITE 200, BOUNTIFUL, UT 84010-7667
(801) 383-1111
(801) 383-1115
Mailing address
1551 RENAISSANCE TOWNE DR STE 200, BOUNTIFUL, UT 84010-7668
(801) 383-1111
(801) 383-1115
Taxonomy
Speciality
Code
Description
License number
State
261QA1903X
Ambulatory Surgical Clinic/Center
Primary
2006-31532
UT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
870630186001
—
UT
Enumeration date
05/15/2006
Last updated
10/28/2009
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