Healthcare Provider Details

I. General information

NPI: 1225496334
Provider Name (Legal Business Name): MOUNTAIN MEDICAL SYSTEMS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/03/2016
Last Update Date: 01/25/2022
Certification Date: 01/25/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

563 W 500 S STE 245
BOUNTIFUL UT
84010-8290
US

IV. Provider business mailing address

PO BOX 1687
BOUNTIFUL UT
84011-1687
US

V. Phone/Fax

Practice location:
  • Phone: 801-663-6015
  • Fax: 435-602-1105
Mailing address:
  • Phone: 801-663-6015
  • Fax: 435-602-1105

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code332BC3200X
TaxonomyCustomized Equipment (DME)
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier122566261714
Identifier TypeOTHER
Identifier StateUT
Identifier IssuerUTAH DEPARTMENT OF COMMERCE DIVISION OF OCCUPATIONAL AND PERSONAL LICENSING

VIII. Authorized Official

Name: JEFFREY ANDERSON
Title or Position: OWNER
Credential:
Phone: 801-663-6015