Organization
ORTHO MEDICAL SUPPLY INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MIKE VAN JENSEN (PRESIDENT)
(801) 528-7350
Entity
Organization
Contact information
Practice address
3480 WASHINGTON BLVD STE 107, OGDEN, UT 84401-4152
(801) 528-7350
(801) 528-7355
Mailing address
3480 WASHINGTON BLVD STE 107, OGDEN, UT 84401-4152
(801) 528-7350
(801) 528-7355
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
Primary
13746360-004-STC
UT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
13746360
UTAH TAX CERTIFICATE
UT
Enumeration date
01/16/2014
Last updated
01/16/2014
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