Organization
MOUNTAINSTAR CANYON SURGICAL CLINIC LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. DAVID J. KANE (VICE PRESIDENT)
(801) 569-5933
Entity
Organization
Contact information
Practice address
984 MEDICAL DR, SUITE 2, BRIGHAM CITY, UT 84302-3604
(435) 723-0329
(435) 723-0429
Mailing address
984 MEDICAL DR, SUITE 2, BRIGHAM CITY, UT 84302-3604
(435) 723-0329
(435) 723-0429
Taxonomy
Speciality
Code
Description
License number
State
208600000X
Surgery Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1831424324
—
UT
Enumeration date
10/16/2009
Last updated
01/25/2010
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