Organization
CAROLS MASTECTOMY SHOPE
Active
Organization
CAROLS MASTECTOMY SHOPE
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. SHELLIE STENQUIST (OWNER/ MANAGER)
(801) 483-1262
Entity
Organization
Contact information
Practice address
3165 S MAIN ST, S SALT LAKE, UT 84115-3748
(801) 483-1262
(801) 483-1287
Mailing address
3165 S MAIN ST, S SALT LAKE, UT 84115-3748
(801) 483-1262
(801) 483-1287
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
Primary
003872
UT
Other
Enumeration date
09/16/2013
Last updated
01/27/2014
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