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Organization

MY MEDIVAN LLC

Active
Organization subpart
No

Provider details

NPI number
Authorized official
JAQUELYN HERNANDEZ NEMTAC (MANAGING DIRECTOR)
(385) 240-9372
Entity
Organization

Contact information

Practice address
1190 E 5425 S STE 103, OGDEN, UT 84403-5193
(801) 734-7010
Mailing address
1190 E 5425 S STE 103, OGDEN, UT 84403-5193
(801) 734-7010

Taxonomy

Speciality
Code
Description
License number
State
343900000X
Non-emergency Medical Transport (VAN)
Primary

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
NPP8569412
BALSINGER INSURANCE
UT
Enumeration date
03/17/2022
Last updated
03/17/2022
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