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Organization
PULMONARY HEALTH SERVICES
Active
Organization
PULMONARY HEALTH SERVICES
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MISS MARY CANNON (CHIEF EXECUTIVE OFFICER)
(801) 266-0399
Entity
Organization
Contact information
Practice address
2307 N HILL FIELD RD STE 102, LAYTON, UT 84041-6890
(801) 266-0399
(801) 266-0421
Mailing address
4885 S 900 E STE 107, SALT LAKE CITY, UT 84117-3905
(801) 266-0399
(801) 266-0421
Taxonomy
Speciality
Code
Description
License number
State
227800000X
Certified Respiratory Therapist
Primary
6209500-5701
UT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
103007426101
SELECTHEALTH
UT
01
—
44447000001001
BLUE CROSS PROVIDER NUMBER
UT
01
—
61101
HUMANA
UT
01
—
73301
PEHP
UT
01
—
781709
DESERET MUTUAL
UT
01
—
P00291261
RR MEDICARE
UT
01
—
QM000064662
ALTIUS
UT
Enumeration date
05/22/2013
Last updated
08/21/2014
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