Healthcare Provider Details

I. General information

NPI: 1275603888
Provider Name (Legal Business Name): MOUNTAIN WEST MEDICAL INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/09/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

120 S STATE ST SUITE B
CLEARFIELD UT
84015-1010
US

IV. Provider business mailing address

PO BOX 666
CLEARFIELD UT
84089-0666
US

V. Phone/Fax

Practice location:
  • Phone: 801-825-2300
  • Fax: 801-779-0807
Mailing address:
  • Phone: 801-825-2300
  • Fax: 801-779-0807

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332BX2000X
TaxonomyOxygen Equipment & Supplies (DME)
License NumberD67761
License Number StateUT

VIII. Authorized Official

Name: MRS. SHARON WEST
Title or Position: PRESIDENT
Credential:
Phone: 801-825-2300