| NPI | 1588011688 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | LANDON J CLEVERLY Manager/Owner 801-842-6106 |
| Organization Subpart ? | No |
| Primary Taxonomy | 332BC3200X Durable Medical Equipment & Medical Supplies, Customized Equipment (Licence: UT 9784687-1714) |
| Additional Taxonomies | 332BX2000X Durable Medical Equipment & Medical Supplies, Oxygen Equipment & Supplies (Licence: UT 9784687-1714) |
| Enumeration Date | 2016-05-18 |
| Last Update Date | 2021-09-15 |