Healthcare Provider Details

I. General information

NPI: 1609443183
Provider Name (Legal Business Name): MAXANCILLARY, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/04/2021
Last Update Date: 06/04/2021
Certification Date: 06/04/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

596 W 750 S # 310-F
BOUNTIFUL UT
84010-7268
US

IV. Provider business mailing address

596 W 750 S # 310-F
BOUNTIFUL UT
84010-7268
US

V. Phone/Fax

Practice location:
  • Phone: 801-703-3990
  • Fax:
Mailing address:
  • Phone: 801-703-3990
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332BC3200X
TaxonomyCustomized Equipment (DME)
License Number
License Number State

VII. Legacy identifiers

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

VIII. Authorized Official

Name: STEVE ADAMSON
Title or Position: MANAGER
Credential:
Phone: 801-703-3990