Form Surgery Center LLC
NPI 1457863912 · Ambulatory Surgical Clinic/Center · Salt Lake City, UT
Form Surgery Center LLC is a Ambulatory Surgical Clinic/Center organization in Salt Lake City, UT (NPI 1457863912).
Provider details
- NPI number
- 1457863912
- Entity type
- Organization
- Primary specialty
- Ambulatory Surgical Clinic/CenterAmbulatory Health Care Facilities
- Organization subpart
- No
- Authorized official
- Janie Ward, Owner(801) 513-3223
- License
- 4972C (UT)
Specialties & taxonomies
Ambulatory Health Care Facilities
Profile Score
A profile completeness & documented-activity index — NOT a quality, outcomes, or patient-satisfaction rating.
- Registry tenure38% of score
8 yrs in NPPES registry
- Profile completeness38% of score
100% of core fields populated
- Practice footprint23% of score
1 documented practice location
Signals a provider has no public data for (e.g. Medicare claims) are left out of the score entirely — never counted as zero — so providers without that data are not penalized. See the full formula and weights in our methodology.
Practice location
Mailing address
Registry dates
- Enumerated
- 2017-10-24
- Last updated
- 2021-04-05
- Certified
- 2021-04-05
Frequently asked questions
- What is Form Surgery Center LLC's NPI number?
- Form Surgery Center LLC's National Provider Identifier (NPI) is 1457863912, a unique 10-digit ID issued by CMS for use in standard healthcare transactions.
- What type of organization is Form Surgery Center LLC?
- Form Surgery Center LLC is classified in the NPPES registry as Ambulatory Surgical Clinic/Center (Ambulatory Health Care Facilities).
- Where is Form Surgery Center LLC located?
- Form Surgery Center LLC's practice location on file with NPPES is 6322 S 3000 E Ste 170, Salt Lake City, UT 84121-7290.
- What is Form Surgery Center LLC's phone number?
- The practice phone number listed in the NPPES registry for Form Surgery Center LLC is (801) 513-3223.
- Who is the authorized official for Form Surgery Center LLC?
- The authorized official listed on Form Surgery Center LLC's NPPES record is Janie Ward, Owner. The authorized official registers and maintains the organization's NPI and is not necessarily its owner.
- Is Form Surgery Center LLC's NPI active?
- Yes — Form Surgery Center LLC's NPI (1457863912) is active in the NPPES registry as of the last update on 2021-04-05.
Source: CMS NPPES Data Dissemination (June 2026). NPI Central is not affiliated with CMS. Data is provided as-is from the public registry.