Organization
BONFIRE REVENUE
Active
Organization subpart
No
Provider details
NPI number
Authorized official
PRESTON BOUTSIS (CMO)
(877) 647-2455
Entity
Organization
Contact information
Practice address
5547 S WALDEN GLEN DR, MURRAY, UT 84123-7942
(877) 647-2455
Mailing address
8977 S 1300 W # 2046, WEST JORDAN, UT 84088-9274
Taxonomy
Speciality
Code
Description
License number
State
261Q00000X
Clinic/Center
Primary
—
—
332B00000X
Durable Medical Equipment & Medical Supplies
—
—
Other
Enumeration date
10/24/2023
Last updated
10/24/2023
Update your record
If you believe information in your NPPES record is inaccurate, or if you wish to update or deactivate your NPI, you can do so directly with CMS at https://nppes.cms.hhs.gov.
About Stedi
Stedi is the only programmable healthcare clearinghouse. You can use Stedi's APIs to process eligibility checks, claims, remits, and more.
Sign up