NPI 1992182216

South Town Surgery Group, LLC

Organisation Health Maintenance Organization Sandy, UT

Practice location

Address: 10011 S Centennial Pkwy, Sandy, UT 84070-4156
Phone: (501) 404-7246
Mailing address: PO Box 1944, Sandy, UT 84091-1944

Authorised official

Name: Carolina Dela Pava
Title: Administrator
Phone: (501) 404-7246

Registered specialties

Health Maintenance Organization Primary

Managed Care Organizations Taxonomy 302R00000X

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Registry record

NPI: 1992182216
Entity type: Organization
NPI issued: 6 May 2015
Record last updated: 6 May 2015

Reproduced from NPPES, the federal provider registry. The date above is when the provider last updated their own entry, not when we fetched it - a record can be years old and still current in the registry.