MEDICARE: FOREVER YOUNG MEDICAL SERVICES PC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	367500000X	Certified Registered Nurse Anesthetist

General Provider Information

NPI Number	:	1194473520
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	FOREVER YOUNG MEDICAL SERVICES PC

Provider Business Mailing Address
First Line	:	PO BOX 1385
Second Line	:
City	:	IDAHO FALLS
State	:	ID
Zip	:	83403-1385
Country	:	US
Telephone Number	:	208-525-2090
Fax Number	:	208-523-8978

Provider Business Practice Location Address
First Line	:	6322 S 3000 E STE 170
Second Line	:
City	:	SALT LAKE CITY
State	:	UT
Zip	:	84121-7290
Country	:	US
Telephone Number	:	801-513-3223
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	SEAN B YOUNG
Credential	:	CRNA
Telephone Number	:	801-698-9230

Provider Enumeration Date	:	03/15/2022
Last Update Date	:	03/21/2022

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