Organization
TCDME
Active
Organization subpart
No
Provider details
NPI number
Authorized official
CHRISTINE LATHAM (MANAGER)
(801) 800-8375
Entity
Organization
Contact information
Practice address
815 W 200 S, PO BOX 74, PAROWAN, UT 84761-0074
(801) 800-8375
Mailing address
PO BOX 1734, OREM, UT 84059-1734
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
Primary
2016000711468
WY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2016000711468
ED MURRAY, WY SECRETARY OF STATE
WY
01
—
7589290001
PTAN
—
Enumeration date
04/12/2016
Last updated
06/14/2017
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