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Data from the NPPES registry. May not reflect recent changes — verify at nppes.cms.hhs.gov.

FORM SURGERY CENTER LLC

Active Organization

FORM SURGERY CENTER LLC is a Ambulatory Surgical Center organization located in SALT LAKE CITY, Utah. NPI 1457863912 is currently active in the NPPES registry. Verify at CMS.

Ambulatory Surgical Center · SALT LAKE CITY, UT

Registration Details

NPI Number
1457863912
Provider Type
Organization
NPI Issued
Oct 24, 2017 (8.8255119027281 yrs)
Last Updated
Apr 5, 2021
License
4972C (UT)

Practice Information

Address
6322 S 3000 E STE 170
SALT LAKE CITY, UT, 841217290
Browse UT providers · Browse ZIP 84121
Phone
8015133223
Primary Specialty
Ambulatory Surgical Center
261QA1903X

Other Ambulatory Surgical Center Organizations in SALT LAKE CITY, UT

Data sourced from the NPPES National Provider Identifier registry. Healthcare organizations registered in NPPES are assigned an NPI number for use in insurance billing and claims. This information is for informational purposes only. For official verification, use the NPPES NPI Registry.