| NPI | 1093864753 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JANELL I MADONNA Director Of Contracting And Pe 801-587-6464 |
| Organization Subpart ? | No |
| Primary Taxonomy | 2086S0102X Surgery, Surgical Critical Care |
| Additional Taxonomies | 208600000X Surgery |
| Enumeration Date | 2007-01-10 |
| Last Update Date | 2009-04-14 |