Healthcare Provider Details

I. General information

NPI: 1417869314
Provider Name (Legal Business Name): VITAL EDGE MEDICAL, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/17/2026
Last Update Date: 09/17/2026
Certification Date: 09/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11694 S FOX VISTA DR
DRAPER UT
84020-1460
US

IV. Provider business mailing address

11694 S FOX VISTA DR
DRAPER UT
84020-1460
US

V. Phone/Fax

Practice location:
  • Phone: 801-897-3020
  • Fax: 385-324-6610
Mailing address:
  • Phone: 801-897-3020
  • Fax: 385-324-6610

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State

VIII. Authorized Official

Name: LANA ATWOOD
Title or Position: OWNER
Credential:
Phone: 801-897-3020