Organization
FOUR CORNERS MEDICAL SUPPLY
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MS. TAMIE J LOIBL (PRES)
(970) 565-4200
Entity
Organization
Contact information
Practice address
154 S MAIN ST, BLANDING, UT 84511-3733
(435) 678-2250
Mailing address
1108 N MILDRED RD, CORTEZ, CO 81321
(970) 565-4200
(970) 565-2786
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
841071727009
—
UT
Enumeration date
08/03/2006
Last updated
08/27/2008
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