Provider Demographics
NPI:1033757166
Name:MOUNTAIN WEST SPINE AND ORTHOPEDICS, LLC
Entity type:Organization
Organization Name:MOUNTAIN WEST SPINE AND ORTHOPEDICS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:DR
Authorized Official - First Name:KADE
Authorized Official - Middle Name:T
Authorized Official - Last Name:HUNTSMAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:801-414-7420
Mailing Address - Street 1:279 E 5900 S STE 100
Mailing Address - Street 2:
Mailing Address - City:MURRAY
Mailing Address - State:UT
Mailing Address - Zip Code:84107-5422
Mailing Address - Country:US
Mailing Address - Phone:801-314-2225
Mailing Address - Fax:
Practice Address - Street 1:279 E 5900 S STE 100
Practice Address - Street 2:
Practice Address - City:MURRAY
Practice Address - State:UT
Practice Address - Zip Code:84107-5422
Practice Address - Country:US
Practice Address - Phone:801-314-2225
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-12-19
Last Update Date:2020-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Single Specialty