MEDICARE: ORTHO-MED CENTER, INC.

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	332B00000X	Durable Medical Equipment & Medical Supplies	E42342	UT

General Provider Information

NPI Number	:	1235232588
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ORTHO-MED CENTER, INC.

Provider Business Mailing Address
First Line	:	2242 FORT UNION BOULEVARD
Second Line	:	SUITE A4 & A5
City	:	COTTONWOOD HEIGHTS
State	:	UT
Zip	:	84121-5551
Country	:	US
Telephone Number	:	801-272-4253
Fax Number	:	801-273-1283

Provider Business Practice Location Address
First Line	:	2242 FORT UNION BOULEVARD
Second Line	:	SUITE A4 & A5
City	:	COTTONWOOD HEIGHTS
State	:	UT
Zip	:	84121-5551
Country	:	US
Telephone Number	:	801-272-4253
Fax Number	:	801-273-1283

Authorized Official
Title or Position	:	STORE MANAGER
Name	:	MRS. JENNA SHELAYNE PAULSEN
Credential	:
Telephone Number	:	801-272-4253

Provider Enumeration Date	:	09/05/2006
Last Update Date	:	05/11/2012

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