Provider Demographics
NPI:1922396720
Name:WEST SHORES SURGICAL CENTER
Entity type:Organization
Organization Name:WEST SHORES SURGICAL CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:GREGORY
Authorized Official - Middle Name:
Authorized Official - Last Name:BIDDULPH
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:801-969-9669
Mailing Address - Street 1:2792 S 5600 W
Mailing Address - Street 2:SUITE A
Mailing Address - City:WEST VALLEY CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84120-5590
Mailing Address - Country:US
Mailing Address - Phone:801-969-9669
Mailing Address - Fax:801-969-9779
Practice Address - Street 1:2792 S 5600 W
Practice Address - Street 2:SUITE A
Practice Address - City:WEST VALLEY CITY
Practice Address - State:UT
Practice Address - Zip Code:84120-5590
Practice Address - Country:US
Practice Address - Phone:801-969-9669
Practice Address - Fax:801-969-9779
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:NO HODADS LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2011-07-13
Last Update Date:2011-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical