MEDICARE: MEDICAL PREP LLC

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy
1	101YM0800X	Mental Health Counselor
2	171M00000X	Case Manager/Care Coordinator
3	103T00000X	Psychologist
4	163WA0400X	Addiction (Substance Use Disorder) Registered Nurse
5	163W00000X	Registered Nurse

General Provider Information

NPI Number	:	1881555357
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MEDICAL PREP LLC

Provider Business Mailing Address
First Line	:	1799 S WASATCH DR
Second Line	:
City	:	SALT LAKE CITY
State	:	UT
Zip	:	84108-3360
Country	:	US
Telephone Number	:	628-282-5882
Fax Number	:

Provider Business Practice Location Address
First Line	:	32 N GOULD ST
Second Line	:
City	:	SHERIDAN
State	:	WY
Zip	:	82801-6317
Country	:	US
Telephone Number	:	628-282-5882
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	NATHAN RESNICK
Credential	:
Telephone Number	:	628-282-5882

Provider Enumeration Date	:	11/24/2025
Last Update Date	:	12/01/2025

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