Organization
DESERET PEAK ANESTHESIA, LLC
Active
Organization
DESERET PEAK ANESTHESIA, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
KYLE JONES CRNA (PRESIDENT)
(801) 296-2113
Entity
Organization
Contact information
Practice address
2055 N MAIN ST, TOOELE, UT 84074-9819
(435) 843-3600
Mailing address
PO BOX 268, BOUNTIFUL, UT 84011-0268
(801) 296-2113
(801) 296-1715
Taxonomy
Speciality
Code
Description
License number
State
367500000X
Certified Registered Nurse Anesthetist
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000055820
MEDICARE PTAN
UT
Enumeration date
07/30/2006
Last updated
03/27/2017
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