Organization
FOOTHILL MEDICAL SUPPLY, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
WAYNE REAVES (CHIEF FINANCIAL OFFICER)
(801) 492-2704
Entity
Organization
Contact information
Practice address
723 N 1890 W STE 38A, PROVO, UT 84601-1333
(877) 464-5846
(877) 492-2716
Mailing address
723 N 1890 W STE 38A, PROVO, UT 84601-1333
(877) 492-2704
(877) 492-2716
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
Primary
10186558-1714
UT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
622952500
U.S. DEPARTMENT OF LABOR WORKERS' COMPENSATION PROGRAMS
—
01
—
624014500
U.S. DEPARTMENT OF LABOR WORKERS' COMPENSATION PROGRAMS
—
Enumeration date
08/17/2017
Last updated
10/29/2021
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