NPIMap

Organization Active NPI

Canyon Surgical Associates, LLC

  • Specialist
  • Murray, UT
National Provider Identifier
1073534970
Registry record updated Jan 4, 2010
On this page

Key facts

NPPES NPI Registry
Primary specialty
SpecialistTaxonomy code 174400000X
Legal business name
CANYON SURGICAL ASSOCIATES, LLC
Practice address
5171 Cottonwood St
Ste # 650
Murray, UT 84107-5704
Phone
(801) 507-9600
NPI assigned
Jul 23, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jan 4, 2010

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Willem P Vanderwerf, MD
Title
Owner
Phone
(801) 507-9600

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
SpecialistGroup: 193400000X SINGLE SPECIALTY GROUP 174400000X UT Primary

Addresses

Primary practice location

5171 Cottonwood St
Ste # 650
Murray, UT 84107-5704

Mailing address

5171 Cottonwood St
Ste # 650
Murray, UT 84107-5704
Phone (801) 507-9600

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in UT

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20061106000255 UT Part B Supplier - Clinic/Group Practice 3779580774 Receives reassigned benefits from 7 practitioners
Practice locations: Murray, UT; St George, UT

National Provider Directory

National Provider Directory

Locations

5171 S Cottonwood St
Ste 650
Salt Lake City, UT 84107
Phone (801) 507-9600

1250 E 3900 S
Ste 220
Salt Lake Cty, UT 84124
Phone (801) 262-9782

Practitioners & affiliated clinicians

Practitioners 9

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1153612800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1262563200000",
    "number": "1073534970",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5171 COTTONWOOD ST",
            "address_2": "STE # 650",
            "city": "MURRAY",
            "state": "UT",
            "postal_code": "841075704",
            "telephone_number": "801-507-9600"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5171 COTTONWOOD ST",
            "address_2": "STE # 650",
            "city": "MURRAY",
            "state": "UT",
            "postal_code": "841075704",
            "telephone_number": "801-507-9600"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CANYON SURGICAL ASSOCIATES, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-07-23",
        "last_updated": "2010-01-04",
        "status": "A",
        "authorized_official_last_name": "VANDERWERF",
        "authorized_official_first_name": "WILLEM",
        "authorized_official_middle_name": "P",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "801-507-9600",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "174400000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Specialist",
            "state": "UT",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Murray, UT

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 4, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.