Organization
SOUTH TOWN SURGERY GROUP, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
CAROLINA DELA PAVA (ADMINISTRATOR)
(501) 404-7246
Entity
Organization
Contact information
Practice address
10011 S CENTENNIAL PKWY, SANDY, UT 84070-4156
(501) 404-7246
Mailing address
PO BOX 1944, SANDY, UT 84091-1944
(501) 404-7246
Taxonomy
Speciality
Code
Description
License number
State
302R00000X
Health Maintenance Organization
Primary
—
—
Other
Enumeration date
05/06/2015
Last updated
05/06/2015
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