Provider Demographics
NPI:1538698451
Name:UTAH PODIATRIC PHYSICIANS AND SURGEONS GROUP
Entity type:Organization
Organization Name:UTAH PODIATRIC PHYSICIANS AND SURGEONS GROUP
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:LAURA
Authorized Official - Middle Name:
Authorized Official - Last Name:DAY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:515-867-0937
Mailing Address - Street 1:144 S 700 E
Mailing Address - Street 2:
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84102-1357
Mailing Address - Country:US
Mailing Address - Phone:801-532-1822
Mailing Address - Fax:801-527-5443
Practice Address - Street 1:10290 N NORTH COUNTY BLVD STE 103
Practice Address - Street 2:
Practice Address - City:HIGHLAND
Practice Address - State:UT
Practice Address - Zip Code:84003-6012
Practice Address - Country:US
Practice Address - Phone:801-756-1800
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:UTAH PODIATRIC PHYSICIANS AND SURGEONS GROUP LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2017-06-05
Last Update Date:2024-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT7899779-0501213E00000X, 213EP1101X, 213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Multi-Specialty
No213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Multi-Specialty
No213EP1101XPodiatric Medicine & Surgery Service ProvidersPodiatristPrimary Podiatric MedicineGroup - Multi-Specialty