| NPI | 1790794014 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JANELL I MADONNA Director Of Contracting And Pe 801-587-6464 |
| Organization Subpart ? | No |
| Primary Taxonomy | 208600000X Surgery |
| Additional Taxonomies | 2086S0120X Surgery, Pediatric Surgery |
| 208G00000X Thoracic Surgery (Cardiothoracic Vascular Surgery) | |
| Enumeration Date | 2006-08-05 |
| Last Update Date | 2009-04-14 |