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CANYON CREST SURGICAL, LLC
NPI 1205071198
Clinic/Center - Ambulatory Surgical in Draper, UT

Active since December 08, 2008CLIA 46D2350651 · Waiver
11762 S STATE #240, DRAPER, UT 84020(801) 542-7194(801) 542-7193 Get Directions Write a Review

NPPES record last updated: December 8, 2008. Verified against the NPPES registry weekly; last sync: November 01, 2026.

About Canyon Crest Surgical, Llc NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

CANYON CREST SURGICAL, LLC (NPI 1205071198) is a healthcare organization registered as an ambulatory surgical in Draper, Utah and active in the NPI registry since December 2008. The organization holds a CLIA Waiver certificate valid through September 13, 2028 and lists Vickie K Glauser, Office Staff, as its authorized official.

NPPES Registry Identity

NPI1205071198
Entity TypeOrganization
Primary Taxonomy261QA1903X
Legal Business NameCANYON CREST SURGICAL, LLC
Location Address11762 S STATE #240Draper, UT 84020
Mailing Address11762 S State #240Draper, UT 84020 · (801) 542-7194 · Fax (801) 542-7193
Phone(801) 542-7194
Fax(801) 542-7193
Organization SubpartNo
Authorized OfficialVickie K GlauserOffice Staff · (801) 316-1313
Enumeration DateDecember 8, 2008
✔ NPI 1205071198 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyClinic/Center · Ambulatory SurgicalAmbulatory Health Care Facilities
Taxonomy Code261QA1903X
License✔ Licensed in UT · 2008-ASF-86531
11762 S STATE #240, Draper, UT 84020
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CLIA Laboratory Certificates CMS CLIA

Laboratory certificates issued under the Clinical Laboratory Improvement Amendments (CLIA) program, which sets federal quality standards for human laboratory testing in the United States. There is no official CMS crosswalk between CLIA and NPI numbers; these certificates are associated with this NPI by matching facility names, locations and phone numbers in the CMS CLIA registry.

Certificate of Waiver 46D2350651

Canyon Crest Surgical Center · Draper, UT
Active · expires Sep 13, 2028
CLIA Number46D2350651
Laboratory TypeAmbulatory Surgery Center
Certificate Effective DateSeptember 14, 2026
Certificate Expiration DateSeptember 13, 2028
Laboratory DirectorDevan Griner
Laboratory Phone(801) 542-7194
Laboratory LocationCanyon Crest Surgical Center11762 South State Street, Suite 240, Draper, UT 84020
CLIA data matches this NPI record on: Name Phone
This certificate is issued to a laboratory to perform only waived tests.

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Canyon Crest Surgical, LLC's NPI number?

The NPI number for Canyon Crest Surgical, LLC is 1205071198. It was assigned to this organization in the NPPES registry on December 8, 2008.

Where is Canyon Crest Surgical, LLC located?

Canyon Crest Surgical, LLC is located at 11762 S State #240, Draper, UT 84020. The listed phone number is (801) 542-7194.

What is Canyon Crest Surgical, LLC's specialty?

The primary specialty registered for this NPI is Clinic/Center, specializing in Ambulatory Surgical, with taxonomy code 261QA1903X.

Does Canyon Crest Surgical, LLC hold a CLIA laboratory certificate?

Yes. A Certificate of Waiver (number 46D2350651) is associated with this NPI, valid through September 13, 2028. CLIA certificates authorize laboratory testing under the federal Clinical Laboratory Improvement Amendments program.

When was this NPI record last updated?

The NPPES record for Canyon Crest Surgical, LLC was last updated on December 8, 2008. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 17 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.