Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.

Form Surgery Center LLC

Organization Ambulatory Surgical Clinic/Center · NPI 1457863912

Form Surgery Center LLC is an Ambulatory Surgical Clinic/Center in Salt Lake City, Utah. Licensed in Utah. Registered with an NPI since 2017.

Licensed in
UT
In the registry since
2017
What do these letters mean?
LLC — Limited liability company
A form of business registration, not a clinical qualification.

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Practice location Address checks out

6322 S 3000 E Ste 170
Salt Lake City, UT 84121-7290
Phone: (801) 513-3223
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Ambulatory Surgical Clinic/Center (primary) Taxonomy 261QA1903X · Licence 4972C (UT)

Record details

NPI number1457863912
Entity typeOrganization (Type 2)
Organization subpartNo
Authorized official Janie Ward — Owner · (801) 513-3223
NPI enumeratedOctober 24, 2017
Last updated in NPPESApril 5, 2021
Certification dateApril 5, 2021
Mailing address6322 S 3000 E Ste 170, Salt Lake City, UT 84121-7290

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