Organization Active NPI

Utah Spine Care, LLC

Doing business as Utah Spine Care

  • Neurological Surgery Physician
  • Ogden, UT
National Provider Identifier
1700173473
Registry record updated Oct 3, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
Neurological Surgery PhysicianTaxonomy code 207T00000X
License
2626351205 Issued in UT
Legal business name
UTAH SPINE CARE, LLC
Doing business as
Utah Spine Care
Practice address
4403 Harrison Blvd
Ste 1815
Ogden, UT 84403-3271
Phone
(801) 732-5950
Fax
(801) 732-5988
NPI assigned
Jul 1, 2011
Last updated
Oct 3, 2016By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 3, 2016

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

Authorized official

Name
Troy Fuller
Title
Practice Administrator
Phone
(801) 732-5950

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Pain Medicine (Anesthesiology) Physician 207LP2900X 1835611205 UT
Neurological Surgery Physician 207T00000X 2626351205 UT Primary
Physical Medicine & Rehabilitation Physician 208100000X 1765801205 UT

Addresses

Primary practice location

4403 Harrison Blvd
Ste 1815
Ogden, UT 84403-3271

Mailing address

4403 Harrison Blvd
Ste 1815
Ogden, UT 84403-3271
Phone (801) 732-5950

Other names 1

  • Utah Spine Care Doing business as

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 2

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.

NPI Registry JSON

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

{
    "created_epoch": "1309478400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1475452800000",
    "number": "1700173473",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4403 HARRISON BLVD",
            "address_2": "STE 1815",
            "city": "OGDEN",
            "state": "UT",
            "postal_code": "844033271",
            "telephone_number": "801-732-5950",
            "fax_number": "801-732-5988"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4403 HARRISON BLVD",
            "address_2": "STE 1815",
            "city": "OGDEN",
            "state": "UT",
            "postal_code": "844033271",
            "telephone_number": "801-732-5950",
            "fax_number": "801-732-5988"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "UTAH SPINE CARE, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2011-07-01",
        "last_updated": "2016-10-03",
        "status": "A",
        "authorized_official_last_name": "FULLER",
        "authorized_official_first_name": "TROY",
        "authorized_official_title_or_position": "PRACTICE ADMINISTRATOR",
        "authorized_official_telephone_number": "801-732-5950"
    },
    "taxonomies": [
        {
            "code": "207LP2900X",
            "taxonomy_group": "",
            "desc": "Anesthesiology, Pain Medicine",
            "state": "UT",
            "license": "1835611205",
            "primary": false
        },
        {
            "code": "207T00000X",
            "taxonomy_group": "",
            "desc": "Neurological Surgery",
            "state": "UT",
            "license": "2626351205",
            "primary": true
        },
        {
            "code": "208100000X",
            "taxonomy_group": "",
            "desc": "Physical Medicine & Rehabilitation",
            "state": "UT",
            "license": "1765801205",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Utah Spine Care",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Ogden, UT

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 3, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.