Provider Demographics
NPI:1366077273
Name:NPH ANESTHESIA OF UTAH, LLC
Entity type:Organization
Organization Name:NPH ANESTHESIA OF UTAH, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SR MANAGER OF SHARED SERVICES
Authorized Official - Prefix:
Authorized Official - First Name:DIANNA
Authorized Official - Middle Name:
Authorized Official - Last Name:HARRISON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:972-761-5508
Mailing Address - Street 1:2221 LAKESIDE BLVD STE 600
Mailing Address - Street 2:
Mailing Address - City:RICHARDSON
Mailing Address - State:TX
Mailing Address - Zip Code:75082-4416
Mailing Address - Country:US
Mailing Address - Phone:972-422-5941
Mailing Address - Fax:
Practice Address - Street 1:5475 S 500 E
Practice Address - Street 2:
Practice Address - City:OGDEN
Practice Address - State:UT
Practice Address - Zip Code:84405-6905
Practice Address - Country:US
Practice Address - Phone:469-505-1609
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-03-11
Last Update Date:2021-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiologyGroup - Single Specialty