Provider Demographics
NPI:1447267554
Name:CEDAR SURGICAL ASSOCIATES LC
Entity type:Organization
Organization Name:CEDAR SURGICAL ASSOCIATES LC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:CHAD
Authorized Official - Middle Name:W
Authorized Official - Last Name:ANDERSON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:435-586-3402
Mailing Address - Street 1:1811 W ROYAL HUNTE DR STE 3
Mailing Address - Street 2:
Mailing Address - City:CEDAR CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84720-8352
Mailing Address - Country:US
Mailing Address - Phone:435-586-3402
Mailing Address - Fax:435-867-4945
Practice Address - Street 1:1811 W ROYAL HUNTE DR STE 3
Practice Address - Street 2:
Practice Address - City:CEDAR CITY
Practice Address - State:UT
Practice Address - Zip Code:84720-8352
Practice Address - Country:US
Practice Address - Phone:435-586-3402
Practice Address - Fax:435-867-4945
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-02
Last Update Date:2014-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UTEXEMPT261QA1903X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT=========005Medicaid
UT=========005Medicaid
UTF99971Medicare UPIN