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
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