NPIMap

Organization Active NPI

Family Surgical Suite

  • Ambulatory Surgical Clinic/Center
  • West Jordan, UT
National Provider Identifier
1508040221
Registry record updated Dec 18, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
Ambulatory Surgical Clinic/CenterTaxonomy code 261QA1903X
Legal business name
FAMILY SURGICAL SUITE
Practice address
8822 S Redwood Rd
Suite 113
West Jordan, UT 84088-9336
Phone
(801) 495-1064
Fax
(801) 523-1139
NPI assigned
Dec 18, 2007
Last updated
Dec 18, 2007By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Dec 18, 2007

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

Authorized official

Name
Mr. Brian Jan Dehart
Title
Managing Member
Phone
(801) 495-1064

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Ambulatory Surgical Clinic/Center 261QA1903X Primary

Addresses

Primary practice location

8822 S Redwood Rd
Suite 113
West Jordan, UT 84088-9336

Mailing address

8822 S Redwood Rd
Suite 113
West Jordan, UT 84088-9336
Phone (801) 495-1064

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20080213000228 UT Part B Supplier - Ambulatory Surgical Center 6901989003 Receives reassigned benefits from 15 practitioners
2 other NPIs on this enrollment
Practice locations: Murray, UT; West Jordan, UT

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1508040221. Details of each certification follow.

Ambulatory surgical center certification: CCN 46C0001049

Name & address match This certification has no NPI in the Medicare enrollment files. CMS publishes enrollment files for six facility types only, so it was connected to this NPI by matching the name and address CMS publishes for it.

Legal name
Family Surgical Suite
Certification status
Active
Provider type (POS)
Ambulatory surgical center
Participating since
Jul 14, 2008
Last certification
Feb 11, 2021
Ownership / control type
Proprietary
Facility address
8822 South Redwood Road, Suite C113
West Jordan, UT 84088

Other NPIs on the same Medicare enrollment 2

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
46D1086034Family Surgical Suite8822 S Redwood Rd #C113, West Jordan, UT 84088Certificate of waiverJul 1, 2028

National Provider Directory

National Provider Directory
Tax ID family
Family Surgical Suite3 organizations share this tax ID, including this one

Other organizations with this tax ID 2

Organizations that report the same tax identification number in the National Provider Directory.

Locations

8822 S Redwood Rd
Ste 113
West Jordan, UT 84088
Phone (801) 495-1064

Practitioners & affiliated clinicians

Practitioners 22

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

View all 22

NPI Registry JSON

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

{
    "created_epoch": "1197936000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1197936000000",
    "number": "1508040221",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "8822 S REDWOOD RD",
            "address_2": "SUITE 113",
            "city": "WEST JORDAN",
            "state": "UT",
            "postal_code": "840889336",
            "telephone_number": "801-495-1064",
            "fax_number": "801-523-1139"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "8822 S REDWOOD RD",
            "address_2": "SUITE 113",
            "city": "WEST JORDAN",
            "state": "UT",
            "postal_code": "840889336",
            "telephone_number": "801-495-1064",
            "fax_number": "801-523-1139"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "FAMILY SURGICAL SUITE",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-12-18",
        "last_updated": "2007-12-18",
        "status": "A",
        "authorized_official_last_name": "DEHART",
        "authorized_official_first_name": "BRIAN",
        "authorized_official_middle_name": "JAN",
        "authorized_official_title_or_position": "MANAGING MEMBER",
        "authorized_official_telephone_number": "801-495-1064",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "261QA1903X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Ambulatory Surgical",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in West Jordan, UT

Sources for this page

Verify at the official NPI Registry.