Organization
NORTHPOINTE SURGICAL CENTER, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
COMBS JO MELODY (ADMINISTRATOR)
(435) 843-0180
Entity
Organization
Contact information
Practice address
2326 N 400 E STE 100, TOOELE, UT 84074-3460
(435) 843-0180
(435) 843-0181
Mailing address
2326 N 400 E STE 100, TOOELE, UT 84074-3460
(435) 843-0180
(435) 843-0181
Taxonomy
Speciality
Code
Description
License number
State
261QA1903X
Ambulatory Surgical Clinic/Center
Primary
—
UT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
103541
AAAHC - ACCREDITATION
UT
01
—
2014-ASF-UT000647
PROFESSIONAL LICENSE
UT
01
—
4310
X-RAY LICENSE NUMBER
UT
01
—
46C0001058
MEDICARE CERTIFICATION NUMBER
UT
01
—
46D2067524
CLIA
UT
01
—
6194
BUSINESS LICENSE - TOOELE
UT
01
—
6806D882440
GENERAL LIABILITY
UT
01
—
8929365-17014
PROFESSIONAL LICENSE PHARMACY CLASS B
UT
01
—
8929365-8913
PROFESSIONAL LICENSE CONTROLLED SUBSTANCE LICENSE
UT
01
—
U000086465
NORIDIAN PTAN NUMBER
UT
01
—
UT900010
MEDICAL MALPRACTICE
UT
Enumeration date
12/06/2012
Last updated
03/07/2023
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